心脏瓣膜手术同期行心房颤动射频消融术的疗效及术后窦性心律转复的影响因素  

Efficacy and influencing factors of radiofrequency ablation of atrial fibrillation and cardiac valve surgery in the meantime

作　　者：王凯 王云涛 刘博 王立成[1] WANG Kai;WANG Yun-tao;LIU Bo;WANG Li-cheng(The Second Ward of Cardiovascular Surgery,Seventh People's Hospital of Zhengzhou,Zhengzhou 453003,China)

机构地区：[1]郑州市第七人民医院心血管外科二病区,河南省郑州市453003

出　　处：《中国心血管病研究》2020年第11期1001-1005,共5页Chinese Journal of Cardiovascular Research

基　　金：郑州市科技攻关项目(20150093)。

摘　　要：目的回顾性分析心脏瓣膜手术同期行心房颤动(房颤)射频消融术的疗效及影响术后窦性心律转复的因素.方法选取2016年1月至2019年6月在我院行心脏瓣膜手术同期行射频消融(Cox MazeⅣ)术的患者182例.其中男性50例、女性132例,平均年龄(56.16±9.27)岁,术后随访3个月至4年,获取术后3个月、6个月、1年及以后每年的心电图、超声心动图等检查结果和并发症发生情况,评价手术效果及窦性心律转复情况.以术后1年心电图是否为窦性心律分为A、B两组进行比较,对可能影响射频消融术后窦性心律转复的因素进行分析.结果术后痊愈出院179例,死亡3例,2例患者在术后2、6天死于低心排出量综合征,1例死于多器官功能衰竭.术后并发症主要为因出血二次手术、永久起搏器置入、恶性心律失常和急性肾衰竭等.出院时及术后3个月、6个月、1年的窦性心律转复率分别为58.7%、70.2%、68.3%、69.0%,术后1年维持窦性心律的患者左心房和左心室内径明显减小,心脏功能和生活质量明显提高.A、B两组患者在年龄[(54.96±9.15)岁比(58.51±9.05)岁,P=0.032]、体重[(58.51±9.55)kg比(63.24±13.13)kg,P=0.016]、心功能(P=0.012)和术前左心房横径[(52.19±9.15)mm比(63.09±14.49)mm,P<0.05]及瓣膜风湿性病变比例[(55/45)比(34/11),P=0.019]差异均有统计学意义.Logistic多因素分析显示,年龄(OR=0.934,95%CI 0.891~0.980,P=0.006)、体重(OR=0.956,95%CI 0.924~0.989,P=0.010)、术前左心房横径(OR=0.909,95%CI 0.872~0.947,P<0.05)和瓣膜风湿性病变(OR=0.424,95%CI 0.193~0.935,P=0.033)与术后窦性心律转复存在显著相关性.结论心脏瓣膜手术同期行房颤射频消融术的治疗是安全、有效的,对于改善患者心脏功能和心肌重塑有重要意义,年龄、体重、术前左心房横径和瓣膜风湿性病变是影响术后远期疗效的独立危险因素.Objective To analyze the effect of radiofrequency ablation of atrial fibrillation and cardiac valve surgery at the same time and the factors affecting the recovery of sinus rhythm.Methods The clinical data of 182 patients who underwent radiofrequency ablation and cardiac valve surgery meanwhile in our hospital from January 2016 to June 2019 were selected,including 50 males and 132 females,with age(56.16±9.27)years.Follow-up for 3 months to 4 years after surgery,the results of ECG and echocardiography and complications at 3 months,6 months,1 year and every year after operation were obtained for evaluating the efficacy of surgery and the recovery of sinus rhythm.According to whether the ECG was sinus rhythm or not at 1 year after operation,the patients were divided into two groups for comparing and analyzing the factors that might affect the recovery.Results 179 patients were discharged and 3 patients died,of which 2 patients died of low cardiac output syndrome at 2 and 6 days after the operation,one patient died of multiple organ failure.The major perioperative complications included the reoperation for bleeding,permanent pacemaker implantation,malignant arrhythmia and acute renal failure.The atrial fibrillation conversion rates of discharge,3 months,6 months and 1 year after the operation were 58.7%,70.2%,68.3%and 69.0%.The LATD and LVEDD was significantly reduced in patients with sinus rhythm at 1 year after the operation and cardiac function and quality of life were significantly improved.There were significant differences between the two groups in age[(54.96±9.15)years vs.(58.51±9.05)years,P=0.032],weight[(5&51±9.55)kg vs.(63.24±13.13)kg,P=0.016],cardiac function(P=0.012)and left atrial transverse diameter before operation[(52.19±9.15)mm vs.(63.09±14.49)mm,P<0.05]as well rheumatic valve lesion[(55/45)vs.(34/11),P=0.019].Logistic multivariate analysis showed that age(OR=0.934,95%C70.891-0.980,P=0.006),weight(O/?=0.956,95%CI 0.924-0.989,P=0.010),preoperative left atrial diameter(OR=0.909,95%C/0.872-0.947,

关 键 词：心房颤动 心脏瓣膜病 射频消融术 多因素分析 

分 类 号：R654.2[医药卫生—外科学]