瓣膜置换联合同期射频消融改良迷宫术治疗心脏瓣膜病合并心房颤动的效果  

Therapeutic effect of cardiac valve replacement combined with concomitant radiofrequency ablation modified maze operation on valvular heart disease complicated by atrial fibrillation

作　　者：李钰珑 陈国锋[2] 王国锋[2] Li Yulong;Chen Guofeng;Wang Guofeng(Department of Cardic Surgery,Nanyang Second People’s Hospital,Nanyang 473000,China;Department of Cardiac Surgery,the 7th People’s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]南阳市第二人民医院心脏外科,南阳473000 [2]郑州市第七人民医院心外科,郑州450000

出　　处：《中国实用医刊》2024年第4期26-29,共4页Chinese Journal of Practical Medicine

摘　　要：目的研究瓣膜置换(CVR)联合同期射频消融改良迷宫术(MRA)治疗心脏瓣膜病(VHD)合并心房颤动患者的效果。方法随机对照研究。抽取2021年2月至2022年5月郑州市第七人民医院收治的VHD合并心房颤动患者106例,按随机数字表法分为CVR组与MRA组,每组53例。CVR组采用CVR治疗,MRA组采用CVR联合同期MRA治疗。对比两组恢复效果,比较两组手术前后心功能[左房内径(LAD)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、炎症因子[白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)]水平。比较两组并发症发生率。结果MRA组辅助呼吸时间、住院天数短于CVR组,即刻窦性心律恢复率(92.45%,49/53)高于CVR组(69.81%,37/53),P<0.05。术后3个月,MRA组LAD、LVEDD水平低于CVR组,LVEF水平高于CVR组(P<0.05);术后3个月,MRA组IL-6、hs-CRP、IL-1β水平低于CVR组(P<0.05)。MRA组并发症发生率(15.09%,8/53)与CVR组(11.32%,6/53)比较差异未见统计学意义(P>0.05)。结论CVR联合同期MRA治疗VHD合并心房颤动效果显著,能快速恢复窦性心率,缩短住院时间,改善患者心功能和炎症水平,且治疗安全性较高。Objective To investigate the efficacy of cardiac valve replacement(CVR)combined with concomitant radiofrequency ablation modified maze operation(MRA)in the treatment of valvular heart disease(VHD)complicated by atrial fibrillation.Methods The study,conducted as a randomized controlled trail,selected 106 patients with VHD complicated by atrial fibrillation treated in the 7th People’s Hospital of Zhengzhou from February 2021 to May 2022,and they were divided into CVR group and MRA group using a random number table method,with 53 cases in each group.The CVR group was treated by CVR,and the MRA group was treated by CVR combined with concomitant MRA.The recovery effect of the two groups were compared.The cardiac function assessed by left atrial diameter(LAD),left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD),levels of inflammatory factors,including interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and interleukin-1β(IL-1β),of the two groups were compared before and after operation.The incidence of complications of the two groups were compared.Results Compared with the CVR group,the MRA group had shorter duration of artificial ventilation and shorter length of hospital stay,moreover,rate of immediate sinus rhythm recovery of the MRA group(92.45%,49/53)was higher than that of the CVR group(69.81%,37/53),P<0.05.Compared with the CVR group,the MRA group had lower levels of LAD and LVEDD,but higher level of LVEF 3 months after operation(P<0.05).The levels of IL-6,hs-CRP and IL-1βin the MRA group were lower than those in the CVR group 3 months after operation(P<0.05).There was no significant difference in the incidence of complications between the MRA group(15.09%,8/53)and the CVR group(11.32%,6/53),P>0.05.Conclusions CVR combined with concomitant MRA is effective in the treatment of VHD complicated by atrial fibrillation.It can quickly restore sinus heart rate,shorten the length of hospital stay,improve cardiac function and inflammation level,with high safety.

关 键 词：心脏瓣膜病 心房颤动 瓣膜置换 同期射频消融改良迷宫术 

分 类 号：R654.2[医药卫生—外科学]