先天性心脏病合并房颤的改良右侧迷宫Ⅲ型手术疗效观察  

The therapeutic effects of modified right maze typeⅢsurgery on the atrial fibrillation due to congenital heart disease

作　　者：赵曙光[1] 张文立[1] 高伟年[1] 闫芳[1] 陈子英[1] 孙涌泉 崔红占 ZHAO Shuguang;ZHANG Wenli;GAO Weinian(Department of Cardiothoracic Surgery,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院心脏外科,石家庄市050000

出　　处：《河北医药》2020年第23期3529-3533,共5页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20190046)。

摘　　要：目的评价先天性心脏病房颤的病理生理及改良右侧迷宫Ⅲ型手术对先天性心脏病合并房颤的近期疗效。方法 48例先天性心脏畸形合并房颤的患者,根据术中有无接受改良右侧迷宫Ⅲ型手术分为迷宫组(n=25)和对照组(n=23),监测并随访2组患者心律、心脏超声指标及心功能指标。结果迷宫组患者术后早期窦性心律20例,交界性心律3例,房颤2例,随访期间80%维持窦性心律,对照组均为房颤心律。超声心动图检查显示迷宫组术后右心房内径(RA)较对照组明显缩小,差异有统计学意义(P<0.05),术后B型脑钠肽(NT-proBNP>含量也较对照组明显降低,差异有统计学意义(P<0.05),NYHA心脏功能评级迷宫组优于对照组(P<0.05)。结论基于先天性心脏病病理生理的外科房颤设计与分型具有临床实用价值,先天性心脏畸形合并房颤的改良右侧迷宫Ⅲ型手术成功率高,近期疗效满意,具有临床推广价值。Objective To investigate the pathophysiological changes of atrial fibrillation due to congenital heart disease and the short-term effects of modified right maze typeⅢsurgery on the disease.Methods Forty eight patients with congenital malformation of heart complicated by atrial fibrillation were enrolled in the study,who were divided into maze group(n=25)and control group(n=23)according to whether who received modified right maze typeⅢoperation.The heart rhythm,cardiac ultrasound indexes and cardiac function indexes were observed and compared between the two groups.Results There were 20 cases of postoperative early sinus rhythm in maze group,3 case of borderline rhythm,and 2 cases of persistent atrial fibrillation,and 80%of the patients maintained sinus rhythm during follow-up.The inner diameter(RA)of right atrium in maze group was significantly smaller than that in control group(P<0.05),and the NT-proBNP levels were significantly lower than those in control group(P<0.05),however,the NYHA cardiac function rating in maze group was superior to that in control group(P<0.05).Conclusion The design and classification of surgical atrial fibrillation based on the pathophysiology of congenital heart disease has clinical practical value.The modified right maze typeⅢoperation for atrial fibrillation of congenital heart disease has satisfactory short-term effects and has clinical promotion value.

关 键 词：心房颤动 迷宫手术 二尖瓣 

分 类 号：R541.1[医药卫生—心血管疾病]