中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
24期
11157-11161
,共5页
杨灵波%王学宁%张忠杰%王栋
楊靈波%王學寧%張忠傑%王棟
양령파%왕학저%장충걸%왕동
导管消融术%二尖瓣%巨大左心房%左心房折叠
導管消融術%二尖瓣%巨大左心房%左心房摺疊
도관소융술%이첨판%거대좌심방%좌심방절첩
Catheter ablation%Mitral valve%Giant left atrium%Left atrium plication
目的：对比左心房折叠（LAP）与射频消融（RFA）对重症二尖瓣病变合并巨大左心房的临床效果。方法2010年7月至2013年6月，38例重症二尖瓣病变合并巨大左心房[左心房内径＞100 mm，心胸比（C/T）＞0.8]患者，随机分为三组：LAP组16例（二尖瓣置换＋LAP）、RFA组10例（二尖瓣置换＋RFA）和对照组12例（二尖瓣置换）。观察术中、后临床指标，并随访3～40个月，比较三组术后左心房大小、心功能改善及窦性心律恢复率等指标。结果术后早期死亡3例，对照组2例死于低心排综合征和肺部感染，RFA组1例死于术后肺部感染。LAP组体外循环时间、ICU时间、呼吸机辅助时间、低心排综合征及肺部感染发生率均低于对照组（P＜0.05）；RFA组主动脉阻断时间和体外循环时间明显高于对照组（P＜0.05），肺部感染发生率低于对照组（P＜0.05），而 ICU 时间、呼吸机辅助时间及低心排综合征发生率与对照组无明显差异（P＞0.05）。术后3个月，与术前资料相比较，三组患者左心房内径[LAP组（P＜0.01）、RFA组（P＜0.05）、对照组（P＜0.05）]均较术前明显缩小；术后三组患者C/T均明显缩小（P＜0.01）；NYHA 心功能分级示术后三组患者心功能均有明显改善（P＜0.05）；术后三组 LVEF 均明显升高[LAP组（P＜0.01）、RFA组（P＜0.05）、对照组（P＜0.05）]。术后3个月，与对照组比较， LAP组在左心房内径（P＜0.01）、C/T（P＜0.05）、NYHA分级（P＜0.05）以及LVEF（P＜0.05）方面均有显著差异；而 RFA 组的上述各指标与对照组均无明显差异（P＞0.05）。三组患者窦性心律恢复率在术后3个月无明显差异（P＞0.05）。术后随访的3～40个月中，1例失访，1例于2年后死于脑卒中，其余患者心脏大小、C/T以及心功能均有明显改善。结论对于重症二尖瓣病变合并巨大左心房的患者，LAP术可以明显改善心肺功能，安全、高效，优于RFA术，而RFA术并没有明显提高术后窦性心律的恢复率，需慎重选择。LAP联合RFA能否进一步提高疗效，有待进一步研究。
目的：對比左心房摺疊（LAP）與射頻消融（RFA）對重癥二尖瓣病變閤併巨大左心房的臨床效果。方法2010年7月至2013年6月，38例重癥二尖瓣病變閤併巨大左心房[左心房內徑＞100 mm，心胸比（C/T）＞0.8]患者，隨機分為三組：LAP組16例（二尖瓣置換＋LAP）、RFA組10例（二尖瓣置換＋RFA）和對照組12例（二尖瓣置換）。觀察術中、後臨床指標，併隨訪3～40箇月，比較三組術後左心房大小、心功能改善及竇性心律恢複率等指標。結果術後早期死亡3例，對照組2例死于低心排綜閤徵和肺部感染，RFA組1例死于術後肺部感染。LAP組體外循環時間、ICU時間、呼吸機輔助時間、低心排綜閤徵及肺部感染髮生率均低于對照組（P＜0.05）；RFA組主動脈阻斷時間和體外循環時間明顯高于對照組（P＜0.05），肺部感染髮生率低于對照組（P＜0.05），而 ICU 時間、呼吸機輔助時間及低心排綜閤徵髮生率與對照組無明顯差異（P＞0.05）。術後3箇月，與術前資料相比較，三組患者左心房內徑[LAP組（P＜0.01）、RFA組（P＜0.05）、對照組（P＜0.05）]均較術前明顯縮小；術後三組患者C/T均明顯縮小（P＜0.01）；NYHA 心功能分級示術後三組患者心功能均有明顯改善（P＜0.05）；術後三組 LVEF 均明顯升高[LAP組（P＜0.01）、RFA組（P＜0.05）、對照組（P＜0.05）]。術後3箇月，與對照組比較， LAP組在左心房內徑（P＜0.01）、C/T（P＜0.05）、NYHA分級（P＜0.05）以及LVEF（P＜0.05）方麵均有顯著差異；而 RFA 組的上述各指標與對照組均無明顯差異（P＞0.05）。三組患者竇性心律恢複率在術後3箇月無明顯差異（P＞0.05）。術後隨訪的3～40箇月中，1例失訪，1例于2年後死于腦卒中，其餘患者心髒大小、C/T以及心功能均有明顯改善。結論對于重癥二尖瓣病變閤併巨大左心房的患者，LAP術可以明顯改善心肺功能，安全、高效，優于RFA術，而RFA術併沒有明顯提高術後竇性心律的恢複率，需慎重選擇。LAP聯閤RFA能否進一步提高療效，有待進一步研究。
목적：대비좌심방절첩（LAP）여사빈소융（RFA）대중증이첨판병변합병거대좌심방적림상효과。방법2010년7월지2013년6월，38례중증이첨판병변합병거대좌심방[좌심방내경＞100 mm，심흉비（C/T）＞0.8]환자，수궤분위삼조：LAP조16례（이첨판치환＋LAP）、RFA조10례（이첨판치환＋RFA）화대조조12례（이첨판치환）。관찰술중、후림상지표，병수방3～40개월，비교삼조술후좌심방대소、심공능개선급두성심률회복솔등지표。결과술후조기사망3례，대조조2례사우저심배종합정화폐부감염，RFA조1례사우술후폐부감염。LAP조체외순배시간、ICU시간、호흡궤보조시간、저심배종합정급폐부감염발생솔균저우대조조（P＜0.05）；RFA조주동맥조단시간화체외순배시간명현고우대조조（P＜0.05），폐부감염발생솔저우대조조（P＜0.05），이 ICU 시간、호흡궤보조시간급저심배종합정발생솔여대조조무명현차이（P＞0.05）。술후3개월，여술전자료상비교，삼조환자좌심방내경[LAP조（P＜0.01）、RFA조（P＜0.05）、대조조（P＜0.05）]균교술전명현축소；술후삼조환자C/T균명현축소（P＜0.01）；NYHA 심공능분급시술후삼조환자심공능균유명현개선（P＜0.05）；술후삼조 LVEF 균명현승고[LAP조（P＜0.01）、RFA조（P＜0.05）、대조조（P＜0.05）]。술후3개월，여대조조비교， LAP조재좌심방내경（P＜0.01）、C/T（P＜0.05）、NYHA분급（P＜0.05）이급LVEF（P＜0.05）방면균유현저차이；이 RFA 조적상술각지표여대조조균무명현차이（P＞0.05）。삼조환자두성심률회복솔재술후3개월무명현차이（P＞0.05）。술후수방적3～40개월중，1례실방，1례우2년후사우뇌졸중，기여환자심장대소、C/T이급심공능균유명현개선。결론대우중증이첨판병변합병거대좌심방적환자，LAP술가이명현개선심폐공능，안전、고효，우우RFA술，이RFA술병몰유명현제고술후두성심률적회복솔，수신중선택。LAP연합RFA능부진일보제고료효，유대진일보연구。
Objective To compare the clinical effects of left atrial plication (LAP) and radiofrequency ablation (RFA) for severe mitral valve disease with giant left atrium. Methods From July 2010 to June 2013, 38 patients with severe mitral valve disease and giant atrium [left atrium diameter over 100 mm and cardiothoracic ratio(C/T) over 0.8] were randomly divided into three groups. Patients in Group LAP (n=16) were treated by mitral valve replacement (MVR) and LAP. Patients in Group RFA (n=10) were treated by MVR and RFA. And patients in Group Control were only treated by MVR. The clinical data of three groups in perioperative period was observed and all patients were followed up from 3 to 40 months. Left atrium size, cardiac function and rate of restoration to sinus rhythm in three groups were compared. Results 3 cases were died in early postoperative period. 2 cases in Group Control died of low cardiac syndrome and lung infection and 1 case in Group RFA died of lung infection. Cardiopulmonary bypass time, ICU time, mechanical ventilation time, and the incidence of low output cardiac syndrome and lung infection in Group LAP were significantly lower than those in Group Control (P<0.05). Aortic clamping time and cardiopulmonary bypass time in Group RFA were obviously higher than those in Group Control (P<0.05), and the incidence of lung infection was significantly lower than that in Group Control (P<0.05). While ICU time, mechanical ventilation time and the incidence of low output cardiac syndrome between Group RFA and Group Control had no significant difference (P>0.05). The left atrium diameters in 3 months after operation in three groups were all significant decreased than before operation (P<0.01 in Group LAP, P<0.05 in Group RFA and P<0.05 in Group Control, respectively). And the ratio of C/T in 3 groups in 3 months after operation was also reduced obviously than before operation. The data of NYHA heart function classification shows that cardiac function in three groups was improved significantly (P<0.05). The LVEF was also increased significantly (P<0.01 in Group LAP, P<0.05 in Group RFA and P<0.05 in Group Control respectively). The rate of restoration to sinus rhythm in three groups had no significant difference (P>0.05). By followed up from 3 to 40 months, one case was lost to follow-up and another case died of stroke after 2 years. The cardiac size, C/T and cardiac function of other cases were improved significantly. Conclusions For the patients with severe mitral valve disease and giant left atrium, LAP during MVR, better than RFA, can improve cardiac and pulmonary function safely and effectively. For these patients, RFA during MVR could not significantly increase the rate of restoration to sinus rhythm and should be chosen carefully. Whether LAP combined with RFA during MVR could improve the clinical effects need to be studied further.
