瓣膜置换联合左心房后壁"X"型消融在不同左心房大小患者中其消融疗效、心室重构和心功能的对比研究  

Comparative study the curative effect, ventricular remodeling and cardiac function of patients in different left atria size undergoing valve replacement with " X" ablation of posterior left atrium wall

作　　者：余杨 严宇 余浪 熊锐 吴洪坤 喻鹏凌 何勇 陈灏 Yu Yang;Yan Yu;Yu Lang;Xiong Rui;Wu Hongkun;Yu Pengling;He Yong;Chen Hao(Department of Cardiovascular Surgery,Chongqing General Hospital,University of Chinese Academy of Sciences,Chongqing 401121,China)

机构地区：[1]中国科学院大学重庆医院重庆市人民医院心血管外科,重庆401121

出　　处：《中华胸心血管外科杂志》2022年第10期609-612,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨左心房大小对瓣膜置换联合左心房后壁"X"型射频消融术后消融疗效,心脏形态及功能变化的影响。方法2015年1月至2019年12月,收治二尖瓣病损合并心房颤动患者416例,按左心房大小(前后径60 mm为标准)分组,行瓣膜置换联合左心房后壁"X"型射频消融术,回顾性分析相关临床资料。结果两组患者中除房颤类型、性别、住院时长及并发症外,其余临床资料、手术及围手术期各指标小左心房组均优于大左心房组,差异有统计学意义(P<0.05);两组患者术前及术后各时间点左心室短轴缩短率、射血分数,小左心房组均高于大左心房组,差异有统计学意义(P<0.05);小左心房组术后各时间点的窦性心律转复率,左心房前后径变化率均高于大左心房组,差异有统计学意义(P<0.05);两组患者术后半年肌钙蛋白、肌红蛋白值差异无统计学意义(P>0.05),而其余各时间点,小左心房组B型脑钠肽、肌钙蛋白、肌红蛋白值均低于大左心房组,差异有统计学意义(P<0.05)。结论大左心房会降低瓣膜置换联合心内直视射频消融患者术后的窦性转复及维持率,有更差的心室重构及心脏功能恢复,术前充分评估左心房大小有助于判断预后。Objective To investigate the influence of left atrial size on the ablation efficacy,cardiac morphology and function after valve replacement combined with X-type radiofrequency ablation on posterior wall of left atrium.Methods From January 2015 to December 2019,416 patients with mitral valve disease complicated with atrial fibrillation were divided into two groups according to the size of left atrium(Anteroposterior diameter 60 mm).Valve replacement combined with"X"radiofrequency ablation on posterior wall of left atrium was performed.The clinical data were analyzed retrospectively.Results Except for the AF types,gender,length of stay and postoperative complications,other clinical data,operative and perioperative indicators were better in small left atria group(SLA)than in large left atria group(LLA).The differences were statistically significant(P<0.05).Fractional shortening(FS),ejection fraction(EF)in SLA at any time point were higher than that in LLA,P<0.05.The sinus rhythm conversion rates,the change rate of LA anteroposterior diameter in SLA at postoperative time points were higher than that in LLA,P<0.05.There was no significant difference of cardiac troponin(cTn)and myoglobin(MYO)between the two groups in 6 months after operation,P>0.05.The B-type natriuretic peptide(BNP),cTn,MYO in the other time points were lower than that in LLA,P<0.05.Conclusion Larger left atrium reduces the rate of sinus rhythm conversion and maintenance in patients undergoing valve replacement combined with fibrillation ablation.There were worse ventricular remodeling and cardiac function recovery.Preoperative evaluation of left atrial size is helpful for prognosis.

关 键 词：左心房 瓣膜置换 心房颤动 "X"型射频消融 转复率 

分 类 号：R654.2[医药卫生—外科学]