文章摘要
韦小勇,葛圣林,朱正艳,等.瓣膜手术同期射频消融治疗心房颤动 50例效果观察[J].安徽医药,2022,26(1):147-151.
瓣膜手术同期射频消融治疗心房颤动 50例效果观察
Clinical observation of 50 patients with atrial fibrillation treated by valvular surgery and surgical radiofrequency ablation
  
DOI:10.3969/j.issn.1009-6469.2022.01.034
中文关键词: 心脏瓣膜疾病  心房颤动  导管消融术  瓣膜置换术  射频消融  治疗结果
英文关键词: Heart valve diseases  Atrial fibrillation  Catheter ablation  Valve replacement  Radiofrequency ablation  Treat-ment outcome
基金项目:
作者单位E-mail
韦小勇 安徽医科大学第一附属医院心脏大血管外科安徽合肥 230022  
葛圣林 安徽医科大学第一附属医院心脏大血管外科安徽合肥 230022 aydgsl@sina.com 
朱正艳 安徽医科大学第一附属医院心脏大血管外科安徽合肥 230022  
张成鑫 安徽医科大学第一附属医院心脏大血管外科安徽合肥 230022  
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中文摘要:
      目的探讨合并心房颤动的心脏瓣膜病病人在行瓣膜置换手术的同期实施射频消融治疗心房颤动的早期临床效果。方法回顾性分析 2017年 6月至 2018年 3月,安徽医科大学第一附属医院收治的 100例心脏瓣膜病合并心房颤动的病人的临床资料,根据其手术方式进行分组,单纯实施瓣膜置换术的 50例病人为对照组,在瓣膜置换术的基础上同期实施射频消融术的 50例病人为观察组。对比两组手术病人的术中和术后临床指标,术后生存质量评分、超声心动图参数及心功能( NYHA)分级情况。结果术中体外循环时间、主动脉阻断时间,术后机械通气时间、 24 h引流量及住院时间,两组间差异无统计学意义。观察组术后静息[(86.29±16.14)次 /分比( 96.84±13.45)次 /分, P=0.013]及运动时[(105.94±9.28)次 /分比( 117.81±11.63)次 /分, P <0.001]心率均明显低于对照组,且术后生存质量评分:躯体功能[( 88.56±8.47)分比( 81.28±7.84)分, P<0.001]心理健康[( 85.48±8.36)分比( 75.93±7.57)分, P<0.001],社会关系[(87.93±9.16)分比( 79.16±8.49)分, P<0.001]生活环境[(84.,93±8.89)分比( 75.83±7.37)分, P<0.001]及窦性心律维持率:术后即刻( 88%比 12%,P<0.001)出院时( 90%比 6%,P,<0.001)术后 1个月(90%比 2%,P<0.001)术后 6个月(94%比 0%,P<0.001)均高于对照组。在术后超声心,动图参数及 NYHA分级方面上,,与术前相比,两组病人的左房内,径( LA)、左室舒张末内径( LVEDD)、左室射血分数( LVEF)及 NYHA分级均较术前改善,但观察组中 LA[( 46.7±3.0)mm比( 49.1±2.7)mm,P=0.01]、 LVEDD[( 47.3±4.2)mm比( 50.3±4.2)mm,P<0.01]、 LVEF[( 59.8±3.7)%比( 57.1±
英文摘要:
      Objective To investigate the early effect of synchronous radiofrequency ablation combined with valve replacement forpatients suffering valvular heart disease complicated with atrial fibrillation.Methods The clinical data of 100 patients suffering valvu-lar heart disease complicated with atrial fibrillation in the First Affiliated Hospital of Anhui Medical University from June 2017 toMarch 2018 was retrospectively analyzed. According to the surgical methods, 50 patients who underwent valve replacement alone wereselected as the control group and the other 50 patients who underwent synchronous radiofrequency ablation combined with valve re-placement were selected as the observation group. The intraoperative and postoperative clinical indexes, postoperative life qualityscores, echocardiographic parameters and cardiac function (NYHA) classification were compared between the two groups.Results In-traoperative cardiopulmonary bypass time, aortic cross-clamp time, postoperative mechanical ventilation time, 24h drainage volume andhospitalization time were not significant compared with the control group. Heart rate at rest [(86.29±16.14) vs. (96.84±13.45), P=0.013] and exercise [(105.94±9.28) vs. (117.81±11.63), P<0.001] in the observation group were significantly lower. The life quality scores [so-matic function[ (88.56±8.47) points vs. (81.28±7.84) points, P< 0.001], mental health [(85.48±8.36) points vs. (75.93±7.57) points, P< 0.001], social relations [(87.93±9.16) points vs. (79.16±8.49) points, P<0.001] social relationship [(87.93±9.16) points vs. (79.16±8.49) points, P<0.001], living environment [(84.93±8.89) points vs. (75.83±7.37) points, P<0.001] and sinus rhythm maintenance rate [imme-diately after surgery (88% vs. 12%, P<0.001), at discharge (90% vs. 6%, P<0.001), 1 month after surgery (90% vs. 2%, P< 0.001), and 6 months after surgery (94% vs. 0%, P<0.001) in the observation group were higher significantly than those in the control group. Interms of postoperative echocardiographic parameters and NYHA classification, the left atrial diameter (LA), left ventricular end diastol-ic diameter (LVEDD), left ventricular ejection fraction (LVEF) and NYHA classification in both groups improved compared with beforesurgery. Forthermore, LA [(46.7±3.0)mm vs. (49.1±2.7)mm, P=0.01], LVEDD [(47.3±4.2 )mm vs. (50.3±4.2)mm, P<0.01], LVEF [(59.8± 3.7)% vs. (57.1±3.9)%, P=0.01] in the observation group were better than those in the control group at 6 months after surgery. Mean-while, the proportion of NYHA≥Ⅱ patients in the observation group was also higher than that in the control group (86% vs. 68 %, P= 0.032).Conclusion The implementation of valve replacement combined with synchronous radiofrequency ablation for patients withvalvular heart disease and atrial fibrillation can effectively promote the recovery of sinus rhythm and improving cardiac function, im-prove their clinical efficacy and life quality.
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