迷宫Ⅳ术治疗心脏瓣膜病合并持续性心房颤动老年患者的队列研究  

MazeⅣin the treatment of heart valve disease with persistent atrial fibrillation in elderly patients:A cohort study

作　　者：浮志坤[1] 杨慧娟[1] 张向立[1] 张曙光 杨恒[1] 朱勇锋[1] 杜鹏 FU Zhikun;YANG Huijuan;ZHANG Xiangli;ZHANG Shuguang;YANG Heng;ZHU Yongfeng;DU Peng(Department of Cardiac Surgery,The Seventh People's Hospital of Zhengzhou,Cardiovascular Disease Hospital of Zhengzhou,Zhengzhou,450012,P.R.China)

机构地区：[1]郑州市第七人民医院郑州市心血管病医院心脏外科,郑州450012

出　　处：《中国胸心血管外科临床杂志》2020年第12期1413-1417,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2018年河南省医学科技攻关计划联合共建项目(2018020861)。

摘　　要：目的探讨迷宫Ⅳ(MazeⅣ)术治疗心脏瓣膜病合并持续性心房颤动(房颤)老年患者的临床效果。方法回顾性分析2017~2018年我院心脏外科因心脏瓣膜病合并持续性房颤老年患者78例的临床资料,其中37例在心脏瓣膜置换术同期行MazeⅣ术治疗房颤(试验组),41例患者单纯行心脏瓣膜置换术(对照组)。试验组男21例、女16例,年龄61~74(65.2±2.5)岁;对照组中男23例、女18例,年龄62~76(64.8±3.3)岁。比较两组临床效果。结果两组患者基线资料差异无统计学意义(P>0.05)。试验组的主动脉阻断时间、体外循环时间、手术操作时间较对照组延长,差异有统计学意义(P<0.05)。术后呼吸机辅助时间、并发症发生率、病死率、ICU滞留时间、围术期引流量、红细胞输注量、住院时间差异无统计学意义(P>0.05)。试验组出院时、术后1个月、3个月、6个月、12个月窦性心律维持率较对照组差异有统计学意义(P<0.05),试验组术后3个月左房内径、左室舒张期末内径、肺动脉收缩压下降值较对照组差异有统计学意义(P<0.05)。结论MazeⅣ术在治疗心脏瓣膜病合并持续性房颤老年患者中安全有效,有利于患者窦性心律的转复和维持,有利于左房、左室的重塑和肺动脉收缩压的降低,能够明显提高患者的生活质量,值得临床推广。Objective To investigate the clinical effect of MazeⅣin the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation(AF).Methods We retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018.The patients were allocated to two groups including a trial group(n=37)and a control group(n=41).There were 21 males and 16 females aged 61 to 74(65.2±2.5)years in the trial group.There were 23 males and 18 females aged 62 to 76(64.8±3.3)years in the control group.The clinical effects of the two groups were compared.Results There was no statistical difference in baseline data between the two groups(P>0.05).The aortic occlusion time,extracorporeal circulation time,and operation time of the trial group were longer than those of the control group with statistical differences(P<0.05).There was no statistical difference in postoperative ventilator assistance time,complication rate,mortality,ICU retention time,perioperative drainage,red blood cell transfusion volume,or length of hospital stay between the two groups(P>0.05).At the time of discharge,postoperaive 1-month,3-month,6-month,and 12-month,the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group(P<0.05).Compared with the control group,left atrial diameter,left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different(P<0.05).Conclusion MazeⅣis safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF,which is conducive to the recovery and maintenance of sinus rhythm,and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.

关 键 词：MazeⅣ术 心脏瓣膜病 持续性心房颤动 老年患者 

分 类 号：R654.2[医药卫生—外科学]