中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
1期
91-94
,共4页
都彩菊%刘效波%赵晓华%张海洲
都綵菊%劉效波%趙曉華%張海洲
도채국%류효파%조효화%장해주
风湿性心脏病%心房颤动%复律%瓣膜置换术
風濕性心髒病%心房顫動%複律%瓣膜置換術
풍습성심장병%심방전동%복률%판막치환술
Rheumatic heart valve disease%Atrial fibrillation%Conversion%Valve replacement
目的 探讨术前干预对风湿性心脏病瓣膜置换术后住院期间心房颤动发作的影响及其他影响因素.方法 将108例风湿性心脏病合并心房颤动行瓣膜置换术患者随机分为治疗组和对照组各54例.治疗组术前给予雷米普利、非洛地平、辛伐他汀三联治疗1个月及常规术前治疗;对照组只给予常规术前治疗.观察比较2组患者术后住院期间心房颤动发作情况.结果 治疗组与对照组复跳后即刻心房颤动的发生率差异无统计学意义(35.85%与41.51%,P=0.55),术后24 h心房颤动的发生率有统计学意义(39.62%与60.38%,χ2=4.57,P=0.03),住院期间心房颤动的发生率也有统计学意义(47.17%与69.81%,χ2=5.59,P=0.02).Logistic回归分析显示术前干预对术后住院期间心房颤动发作有影响(OR=0.39,95% CI0.17～0.86,P=0.018);影响心房颤动发作的主要因素还有左心房内径(OR=4.28,95% CI1.12～18.23,P=0.008)、心房颤动持续时间(OR=4.19,95%CI 1.15～14.22,P=0.011)、肺动脉压力(OR=3.28,95%CI 1.14～12.25,P=0.012)等.ROC曲线显示预测心房颤动时左心房内径最佳截点值为46.5 mm,预测房颤发作的敏感性为73%,特异度为85%;肺动脉压力最佳截点值为48.5 mm Hg,其敏感性为75.6%,特异度为80.3%;心房颤动持续时间最佳截点值为7.5个月,敏感性为76.1%,特异度为88.3%.结论 术前积极干预对心脏瓣膜置换术后住院期间可减少心房颤动的发生率,对术后窦性心律的维持也有有益的作用.
目的 探討術前榦預對風濕性心髒病瓣膜置換術後住院期間心房顫動髮作的影響及其他影響因素.方法 將108例風濕性心髒病閤併心房顫動行瓣膜置換術患者隨機分為治療組和對照組各54例.治療組術前給予雷米普利、非洛地平、辛伐他汀三聯治療1箇月及常規術前治療;對照組隻給予常規術前治療.觀察比較2組患者術後住院期間心房顫動髮作情況.結果 治療組與對照組複跳後即刻心房顫動的髮生率差異無統計學意義(35.85%與41.51%,P=0.55),術後24 h心房顫動的髮生率有統計學意義(39.62%與60.38%,χ2=4.57,P=0.03),住院期間心房顫動的髮生率也有統計學意義(47.17%與69.81%,χ2=5.59,P=0.02).Logistic迴歸分析顯示術前榦預對術後住院期間心房顫動髮作有影響(OR=0.39,95% CI0.17～0.86,P=0.018);影響心房顫動髮作的主要因素還有左心房內徑(OR=4.28,95% CI1.12～18.23,P=0.008)、心房顫動持續時間(OR=4.19,95%CI 1.15～14.22,P=0.011)、肺動脈壓力(OR=3.28,95%CI 1.14～12.25,P=0.012)等.ROC麯線顯示預測心房顫動時左心房內徑最佳截點值為46.5 mm,預測房顫髮作的敏感性為73%,特異度為85%;肺動脈壓力最佳截點值為48.5 mm Hg,其敏感性為75.6%,特異度為80.3%;心房顫動持續時間最佳截點值為7.5箇月,敏感性為76.1%,特異度為88.3%.結論 術前積極榦預對心髒瓣膜置換術後住院期間可減少心房顫動的髮生率,對術後竇性心律的維持也有有益的作用.
목적 탐토술전간예대풍습성심장병판막치환술후주원기간심방전동발작적영향급기타영향인소.방법 장108례풍습성심장병합병심방전동행판막치환술환자수궤분위치료조화대조조각54례.치료조술전급여뢰미보리、비락지평、신벌타정삼련치료1개월급상규술전치료;대조조지급여상규술전치료.관찰비교2조환자술후주원기간심방전동발작정황.결과 치료조여대조조복도후즉각심방전동적발생솔차이무통계학의의(35.85%여41.51%,P=0.55),술후24 h심방전동적발생솔유통계학의의(39.62%여60.38%,χ2=4.57,P=0.03),주원기간심방전동적발생솔야유통계학의의(47.17%여69.81%,χ2=5.59,P=0.02).Logistic회귀분석현시술전간예대술후주원기간심방전동발작유영향(OR=0.39,95% CI0.17～0.86,P=0.018);영향심방전동발작적주요인소환유좌심방내경(OR=4.28,95% CI1.12～18.23,P=0.008)、심방전동지속시간(OR=4.19,95%CI 1.15～14.22,P=0.011)、폐동맥압력(OR=3.28,95%CI 1.14～12.25,P=0.012)등.ROC곡선현시예측심방전동시좌심방내경최가절점치위46.5 mm,예측방전발작적민감성위73%,특이도위85%;폐동맥압력최가절점치위48.5 mm Hg,기민감성위75.6%,특이도위80.3%;심방전동지속시간최가절점치위7.5개월,민감성위76.1%,특이도위88.3%.결론 술전적겁간예대심장판막치환술후주원기간가감소심방전동적발생솔,대술후두성심률적유지야유유익적작용.
Objective To evaluate the influence of preoperation medical treatment on recurrence of atrial fibrillation(AF) in valve replacement postoperative patients of rheumatic heart disease during in-hospital and other risk factors. Methods One-hundred and eight patients with rheumatic heart disease and AF that underwent valve replacement postoperative patients were randomly divided into 2 groups: the treatment group (n =54)and the control group (n = 54 ). The treatment group were treated with ranipril, felodipine and simvastatin for 1 month and other conventional preoperational treatments before operation . The control group were only treated conventional preoperational therapy. Occurrence of AF postoperation were observed during inhospital. Results The occurrence of atrial fibrillation of the two group was no difference( 35.85% vs 41.51%,P = 0.55) immediately after rebeat. There was significant difference in the occurrence of atrial fibrillation of the 2 groups within 24 h post-operation ( 47.17% vs 69.81%, P = 0.02 ) . Logistic regression showed that intervention before operation had significant effect on the occurrence of AF( OR =0.39,95% CI: 0.17 -0.86,P =0.018) ,as well as the diameter of left atrium (LAD) ( OR= 4.28,95% CI:1.12 - 18.23, P = 0.018 ),pulmonary artery pressure(PAP) ( OR = 3.28,95% CI: 1.14 - 12.25, P = 0.01 ), duration of atrial fibrillation (AFD) (OR = 4.19,95% CI: 1.15 -14.22,P = 0.011). ROC curve showed that the best cut-off of LAD was 46.5 mm to predict AF,with sensitivity of 73% and specify of 85% ;the best cut-off of PAP was 48.5 mm Hg,with sensitivity of 75.6% and specify of 80.3% ;the best cut-off of AFD was 7. 5 months,with sensitivity of 76.1% and specify of 88.3%. Conclusion The recurrence of AF can be effectively reduced during hospitalization by the preoperational triple treatments for patients with rheumatic heart disease successfully underwent valve replacement operation , which is also beneficial for maintenance of sinus rhythm after operation.
