冷冻消融迷宫术联合二尖瓣置换治疗心房功能性二尖瓣反流的回顾性队列研究  

Cryoablation Maze surgery combined with mitral valve replacement for patients with atrial functional mitral regurgitation:A retrospective cohort study

作　　者：梁汉青 韩劲松 尹宗涛 张建 李瑞 万巧丽 郭志鹏 魏韬 LIANG Hanqing;HAN Jinsong;YIN Zongtao;ZHANG Jian;LI Rui;WAN Qiaoli;GUO Zhipeng;WEI Tao(The Graduate Training Base,General Hospital of Northern Theater Command,Jinzhou Medical University,Shenyang,110016,P.R.China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,沈阳110016 [2]北部战区总医院心血管外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2024年第10期1455-1461,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2022年辽宁省应用基础研究(2022JH2/101300085)。

摘　　要：目的探讨二尖瓣置换同期行冷冻消融迷宫术对心房功能性二尖瓣反流(atrial functional mitral regurgitation,AFMR)患者的安全性及疗效。方法回顾性分析2014年1月—2020年6月于北部战区总医院心血管外科行二尖瓣置换AFMR患者的临床资料。根据治疗方法将患者分为两组,同期行冷冻消融迷宫术为消融组,未行冷冻消融迷宫术为非消融组。比较两组患者的基线资料、手术资料、疗效和预后情况。结果共纳入85例患者。消融组40例,其中男16例、女24例,年龄(58.65±6.86)岁;非消融组45例,其中男24例、女21例,年龄(61.29±8.30)岁。两组患者基线资料差异无统计学意义(P>0.05)。消融组的体外循环时间、主动脉阻断时间较非消融组延长,差异有统计学意义(P<0.01)。术后监护室停留时间、呼吸机辅助时间、术后住院时间、术中失血量、术后第1 d引流量、术后不良事件(临时起搏器应用、术后电复律、胸腔穿刺引流、住院死亡)发生率差异均无统计学意义(P>0.05)。消融组出院时、术后3、6、12、24个月窦性心律恢复率与非消融组的差异有统计学意义(P<0.001)。术后24个月超声指标:消融组的左心房内径、左心室舒张末期内径、左心室收缩末期内径、肺动脉收缩压的下降值较非消融组差异有统计学意义(P<0.05)。两组患者术后心功能分级均为Ⅰ级或Ⅱ级,较术前显著改善,但两组差异无统计学意义(P>0.05);随访期间两组不良事件发生率差异无统计学意义(P>0.05)。结论对AFMR患者二尖瓣置换同期行冷冻消融迷宫术,未增加手术风险,术后转复为窦性心律的成功率较高,有利于左心房、左心室重塑和肺动脉收缩压降低,有效改善患者生活质量。Objective To investigate the safety and efficacy of mitral valve replacement combined with cryoablation Maze surgery in patients with atrial functional mitral regurgitation(AFMR).Methods From January 2014 to June 2020,patients with AFMR who underwent mitral valve replacement in our department were enrolled.They were divided into two groups,a cryoablation Maze group who received cryoablation Maze surgery during mitral valve replacement,and a non-cryoablation Maze group who did not receive cryoablation Maze surgery.The baseline data,surgical data,efficacy,and prognosis between the two groups were compared.Results Finally 85 patients were enrolled.There were 16 males and 24 females with an average age of 58.65±6.86 years in the cryoablation Maze group,and 24 males and 21 females with an average age of 61.29±8.30 years in the non-cryoablation Maze group.There was no statistical difference in baseline data between the two groups(P>0.05).The aortic occlusion time and extracorporeal circulation time of the cryoablation Maze group were longer than those of the non-cryoablation Maze group with statistical differences(P<0.01).There was no statistical difference in postoperative ICU retention time,ventilator assistance time,length of hospital stay,intraoperative blood loss,drainage volume on the first day or occurrence rate of complications(temporary pacemaker application,electrical cardioversion,thoracic puncture drainage,hospitalization death)between the two groups(P>0.05).At the time of discharge,postoperative 3-month,6-month,12-month,and 24-month,the maintenance rates of sinus rhythm in the non-cryoablation Maze group were statistically different from those of the cryoablation Maze group(P<0.001).Compared with the non-cryoablation Maze group,the decrease values of left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter and pulmonary artery systolic pressure were statistically different(P<0.05).Postoperative cardiac function grading of both groups was gradeⅠorⅡ,which was

关 键 词：心房功能性二尖瓣反流 功能性二尖瓣反流 冷冻消融迷宫术 二尖瓣置换 心房颤动 

分 类 号：R654.2[医药卫生—外科学]