经心外膜左心耳闭合技术在心脏瓣膜病合并房颤患者中的疗效分析:单术者经验总结  

Clinical efficacy of transepicardial left atrial appendage closure in patients with heart valve disease and atrial fibrillation:experience of a single surgeon

作　　者：刘戈[1] 石宇[1] 张圣强 刁文杰 沈崇文 施超[1] LIU Ge;SHI Yu;ZHANG Shengqiang;DIAO Wenjie;SHEN Chongwen;SHI Chao(Department of Cardiac Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院心脏外科,安徽蚌埠233004

出　　处：《包头医学院学报》2023年第9期49-53,共5页Journal of Baotou Medical College

基　　金：蚌埠医学院自然科学重点专项(2020BYZD110);安徽高校自然科学研究重点项目(KJ2021A0820)。

摘　　要：目的:探讨单术者将术中经心外膜左心耳闭合技术应用于伴有心房颤动的接受瓣膜手术患者的临床疗效。方法:选取2019年6月-2021年12月蚌埠医学院第一附属医院收治的59例患有心房颤动并接受瓣膜手术的患者作为研究对象。根据术中是否应用经心外膜左心耳闭合技术,将患者分为夹闭组(n=29)和非夹闭组(n=30),比较两组患者手术前相关基础资料、围术期各项指标及术后随访数据等。结果:两组患者的年龄、性别、有无左心房内血栓、术前心功能及其他合并基础疾病相比较,差异均无统计学意义(P>0.05)。两组患者术前心脏彩超测量值比较,差异均无统计学意义(P>0.05);夹闭组术前射血分数高于非夹闭组(P<0.05)。两组患者间手术方式比较,差异无统计学意义(P>0.05)。两组患者围术期指标及随访数据比较,夹闭组患者的总手术时间长于非夹闭组,差异有统计学意义(P<0.05);两组患者体外循环时间、阻断升主动脉时间、术后住院时间、术后短期内心房颤动复发及脑卒中事件发生率比较,差异均无统计学意义(P>0.05)。结论:对患有心房颤动并接受瓣膜手术的患者,应常规施行经心外膜左心耳闭合技术,该技术简单实用、安全经济。Objective:To investigate the clinical effect of transepicardial left atrial appendage closure in patients with heart valve disease and atrial fibrillation.Methods:A total of 59 patients with atrial fibrillation who underwent valve surgery in the First Affiliated Hospital of Bengbu Medical College from June 2019 to December 2021 were selected as the research objects.Patients who underwent transepicardial left atrial appendage closure were divided into the clipping group(n=29)and patients who underwent no transepicardial left atrial appendage closure into the non-clipping group(n=30).The basic data before surgery,perioperative indicators and follow-up data of the two groups of patients were compared.Results:There were no statistically significant differences in age,gender,left atrial(LA)thrombosis,preoperative cardiac function,and other underlying diseases between the two groups of patients(P>0.05).There was no significant difference in the preoperative color Doppler ultrasound measured results between the two groups of patients(P>0.05).The preoperative ejection fraction of the clipping group was higher than that of the non-clipping group(P<0.05).There was no statistically significant difference in surgical procedures between the two groups of patients(P>0.05).Comparison of perioperative indicators and follow-up data between the two groups showed that the total operative time of the clipping group was longer than that in the non-clipping group,and the difference was statistically significant(P<0.05).There was no significant difference in the time of cardiopulmonary bypass,ascending aorta occlusion,postoperative hospital stays,recurrence of atrial fibrillation after surgery and stroke incidence between the two groups(P>0.05).Conclusion:For patients with atrial fibrillation undergoing valve surgery,the transepicardial left atrial appendage closure should be routinely performed,which is simple,practical,safe and economical.

关 键 词：经心外膜左心耳闭合技术 心房颤动 瓣膜置换术 瓣膜成形术 

分 类 号：R654.2[医药卫生—外科学]