CAJ | 학술논문

目的对比分析二尖瓣手术同期应用双极射频消融钳行左心房消融术与双心房消融术治疗心房颤动(房颤)的效果.方法 2008年1月至2012年12月,二尖瓣手术同期应用双极射频消融钳行迷宫(Cox Maze)Ⅳ手术109例,其中男43例,女66例;年龄39～ 62岁.根据住院号将患者分为双心房消融组61例(住院号为偶数)和单纯左心房消融组48例(住院号为奇数).术前诊断风湿性心脏病81例,退行性病变28例.房颤病程7个月至13年,其中持续性房颤34例,长程持续性房颤75例.患者均为首次心脏手术,术前检查排除先天性心脏病、冠状动脉粥样硬化性心脏病和甲状腺功能亢进病例.所有患者均在全麻体外循环心脏停跳下行双极钳双心房消融术或单纯左心房消融术.消融完毕,探查二、三尖瓣病变情况,择行瓣膜修复或置换术.术毕常规放置心外膜临时起搏导线.结果全组均顺利完成心脏瓣膜手术及改良迷宫术.双心房消融组术中体外循环时间和主动脉阻断时间均较单纯左心房消融组长,差异有统计学意义(P＜0.001);其它各项指标差异均无统计学意义(P＞0.05).围手术期死亡1例,为左心房消融组二尖瓣修复患者,因肺部感染术后25天死于呼吸衰竭.全组无Ⅲ度房室传导阻滞、冠状动脉损伤及脑卒中等并发症.术毕复跳时均无房颤心律,其中窦性心律94例(86.2％),交界性心律15例.出院时窦性心律95例(95/108,88.0％),其中双心房消融组57例(57/61,93.4％),单纯左心房消融组38例(38/47,80.9％),两组差异有统计学意义,P=0.046.术后随访6个月至5.5年,术后1年时单纯左心房消融组的心房扑动发生比例明显高于双心房消融组(10.6％对0,P=0.032);术后3年累计窦性心律维持率,单纯左心房消融组与双心房消融组差异无统计学意义[(75.6±7.3)％对(89.0±4.4)％,P =0.096].结论二尖瓣病变合并心房颤动患者,双心房消融术能更有效地防止术后心房扑动的发生,更好地恢复和维持窦性心律,且不会增加手术风险. 目的對比分析二尖瓣手術同期應用雙極射頻消融鉗行左心房消融術與雙心房消融術治療心房顫動(房顫)的效果.方法 2008年1月至2012年12月,二尖瓣手術同期應用雙極射頻消融鉗行迷宮(Cox Maze)Ⅳ手術109例,其中男43例,女66例;年齡39～ 62歲.根據住院號將患者分為雙心房消融組61例(住院號為偶數)和單純左心房消融組48例(住院號為奇數).術前診斷風濕性心髒病81例,退行性病變28例.房顫病程7箇月至13年,其中持續性房顫34例,長程持續性房顫75例.患者均為首次心髒手術,術前檢查排除先天性心髒病、冠狀動脈粥樣硬化性心髒病和甲狀腺功能亢進病例.所有患者均在全痳體外循環心髒停跳下行雙極鉗雙心房消融術或單純左心房消融術.消融完畢,探查二、三尖瓣病變情況,擇行瓣膜脩複或置換術.術畢常規放置心外膜臨時起搏導線.結果全組均順利完成心髒瓣膜手術及改良迷宮術.雙心房消融組術中體外循環時間和主動脈阻斷時間均較單純左心房消融組長,差異有統計學意義(P＜0.001);其它各項指標差異均無統計學意義(P＞0.05).圍手術期死亡1例,為左心房消融組二尖瓣脩複患者,因肺部感染術後25天死于呼吸衰竭.全組無Ⅲ度房室傳導阻滯、冠狀動脈損傷及腦卒中等併髮癥.術畢複跳時均無房顫心律,其中竇性心律94例(86.2％),交界性心律15例.齣院時竇性心律95例(95/108,88.0％),其中雙心房消融組57例(57/61,93.4％),單純左心房消融組38例(38/47,80.9％),兩組差異有統計學意義,P=0.046.術後隨訪6箇月至5.5年,術後1年時單純左心房消融組的心房撲動髮生比例明顯高于雙心房消融組(10.6％對0,P=0.032);術後3年纍計竇性心律維持率,單純左心房消融組與雙心房消融組差異無統計學意義[(75.6±7.3)％對(89.0±4.4)％,P =0.096].結論二尖瓣病變閤併心房顫動患者,雙心房消融術能更有效地防止術後心房撲動的髮生,更好地恢複和維持竇性心律,且不會增加手術風險.
목적 대비분석이첨판수술동기응용쌍겁사빈소융겸행좌심방소융술여쌍심방소융술치료심방전동(방전)적효과.방법 2008년1월지2012년12월,이첨판수술동기응용쌍겁사빈소융겸행미궁(Cox Maze)Ⅳ수술109례,기중남43례,녀66례;년령39～ 62세.근거주원호장환자분위쌍심방소융조61례(주원호위우수)화단순좌심방소융조48례(주원호위기수).술전진단풍습성심장병81례,퇴행성병변28례.방전병정7개월지13년,기중지속성방전34례,장정지속성방전75례.환자균위수차심장수술,술전검사배제선천성심장병、관상동맥죽양경화성심장병화갑상선공능항진병례.소유환자균재전마체외순배심장정도하행쌍겁겸쌍심방소융술혹단순좌심방소융술.소융완필,탐사이、삼첨판병변정황,택행판막수복혹치환술.술필상규방치심외막림시기박도선.결과 전조균순리완성심장판막수술급개량미궁술.쌍심방소융조술중체외순배시간화주동맥조단시간균교단순좌심방소융조장,차이유통계학의의(P＜0.001);기타각항지표차이균무통계학의의(P＞0.05).위수술기사망1례,위좌심방소융조이첨판수복환자,인폐부감염술후25천사우호흡쇠갈.전조무Ⅲ도방실전도조체、관상동맥손상급뇌졸중등병발증.술필복도시균무방전심률,기중두성심률94례(86.2％),교계성심률15례.출원시두성심률95례(95/108,88.0％),기중쌍심방소융조57례(57/61,93.4％),단순좌심방소융조38례(38/47,80.9％),량조차이유통계학의의,P=0.046.술후수방6개월지5.5년,술후1년시단순좌심방소융조적심방복동발생비례명현고우쌍심방소융조(10.6％대0,P=0.032);술후3년루계두성심률유지솔,단순좌심방소융조여쌍심방소융조차이무통계학의의[(75.6±7.3)％대(89.0±4.4)％,P =0.096].결론 이첨판병변합병심방전동환자,쌍심방소융술능경유효지방지술후심방복동적발생,경호지회복화유지두성심률,차불회증가수술풍험.
Objective The purpose of this study was to compare the outcome after biatrial ablation or left atrial ablation in patients with atrial fibrillation(AF) associated with mitral valve diseases.Methods All 109 patients who received biatrial ablation (n =61) or left atrial ablation (n =48) of atrial fibrillation combined with mitral valve surgery from January 2008 to December 2012 were analyzed for outcome differences.The etiology of mitral valve disease was rheumatic(n =81) and degenerative(n =28).Age at operation ranged from 39 to 62 years.AF duration ranged from 7 months to 13 years.Clinical manifestations of atrial fibrillation were persistent in 34 patiens and long-standing persistent in 75 patients.Results All patients successfully underwent radiofrequency modified maze procedure and mitral valve surgery.The biatrial ablation group had longer cardiopulmonary bypass time and crossclamp time.But there was no significant difference in mechanical ventilation,hospital length of stay and major postoperative complications or other postoperative outcome variables between biatrial ablation and lefi atrial ablation groups.There was 1 early death in left arial ablation group.At postoperative moment,the elimination rate of atrial fibril lation were 100％ (sinus rhythm in 94 and junctional rhythm in 15).At discharge,maintenance of normal sinus rhythm was 93.4％ in biatrial group and 80.9％ in left atrial group (P =0.046).Cumulative maintenance of normal sinus rhythm without atrial fibrillation recurrence at 3 years postoperatively was (89.0 ± 4.4) ％ in biatrial group and (75.6 ± 7.3) ％ in left atrial group,P =0.096.But the incidence of atrial flutter at 1 year postoperatively in left atrial group(10.6％) was significantly higher than the biatrial group (0),P =0.032.Conclusion Compared with left atrial ablation,biatrial ablation was more effective in restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.In addition,biatrial ablation was more effective in preventing the occurrence of postoperative atrial flutter.