改良左侧迷宫Ⅲ型手术对不同病理生理分型风湿性二尖瓣病变房颤的效果  

The pathophysiological typing of atrial fibrillation due to rheumatic mitral valve lesion and the investigation of modified left maze typeⅢoperation

作　　者：赵曙光[1] 张文立[1] 高伟年[1] 闫芳[1] 陈子英[1] 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24期3733-3737,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：目的通过外科房颤疾病的病理生理分析,对外科房颤进行分型,评估风湿性二尖瓣Ⅰ型房颤的改良左侧迷宫Ⅲ型手术疗效。方法选取2015年4月至2019年6月风湿性二尖瓣病变合并房颤患者20例。基于心脏原发疾病病理生理对外科房颤进行分型,制定适于不同类型房颤的改良迷宫手术,针对风湿性瓣膜病合并的房颤,在实施瓣膜手术的同时实施改良左侧迷宫Ⅲ型手术,监测患者围术期相关指标及术后心律、血清cTnT、心脏超声指标及心功能。结果依据房颤分型所实施的改良左侧迷宫Ⅲ型手术患者随访期间85%维持窦性心律,超声心动图检查显示迷宫术后患者左心房较术前明显缩小、左心室射血分数有明显提高(P<0.05),血清cTnT术后一过性增高,NYHA心脏功能评级术后有明显改善(P<0.05)。结论针对左心房进行机械隔离的改良左侧迷宫Ⅲ型手术对风湿性二尖瓣合并的房颤疗效满意,具有较高手术成功率和低并发症,具有临床推广价值。Objective To investigate the curative effects of the modified left maze typeⅢoperation in treatment of rheumatic mitral valve typeⅠatrial fibrillation through the pathophysiological analysis of surgical atrial fibrillation disease.Methods A total of 20 patients with rheumatic mitral valve lesion complicated by atrial fibrillation who were treated in our hospital from April 2015 to July 2019 were enrolled in the study.The typing of atrial fibrillation was performed based on the pathophysiology of primary cardiac disease,and a modified maze operation was formulated for different types of atrial fibrillation.Aimed at the rheumatic valvular heart disease complicated atrial fibrillation,the modified left maze typeⅢoperation was performed at the same time of carrying out the valve operation.The related indexes at perioperative period,and the heart rhythm,and the serum levels of cTnT,the indexes of cardiac uhrasonography and cardiac function of patients after operation were monitored.Results At the follow-up period,the 85%of the patients who were treated by modified left maze typeⅢoperation according to the classification of the atrial fibrillation maintained the sinus rhythm.Moreover the ultrasonic cardiogram examination showed that after the labyrinth operation,the patients’atria sinistrum was significantly decreased,however the left ventricular ejection fraction(LVEF)was significantly increased(P<0.05).After operation,the serum levels of cTnT were increased transiently,and the NYHA cardiac function rating was significantly improved(P<0.05).Conclusion The modified left maze typeⅢoperation with mechanical isolation has satisfactory therapeutic effects on rheumatic mitral valve lesion complicated by atrial fibrillation,which has higher success rate of operation and lower complication,therefor,which has clinical promotion value.

关 键 词：心房颤动 迷宫手术 二尖瓣 

分 类 号：R541.2[医药卫生—心血管疾病]