CAJ | 학술논문

目的比较风湿性心脏病瓣膜置换术中应用单极及双极射频消融改良迷宫术治疗永久性心房纤颤的中远期疗效.方法青岛大学附属医院共为151例风湿性心脏瓣膜病合并永久性心房纤颤的患者术中同期行瓣膜置换及射频消融术,其中应用单极射频消融79例(单极组),双极射频消融72例(双极组).收集所有患者的术前资料,术后随访3～6年,获得患者术后即刻、出院时、3、6个月、1年及随后每年的十二导联心电图(或24 h动态心电图)及心脏超声心动图结果,并记录患者术后并发症及心功能、生活质量改善等情况.比较两组患者心房纤颤消除率(窦性心律+结性心律)、手术时间、术后引流量、术后住院时间、围术期严重并发症及死亡率等.结果与单极射频消融组比较,双极射频消融组射频消融时间长[(31.5±3.9) min比(17.1±2.5)min,P＜0.01],差异有统计学意义;而升主动脉阻断时间[(61.4 ±20.1)min比(57.0 ±21.6) min,P＞0.05]及体外循环时间[(104.1 ±27.1)min比(93.9±37.9) min,P＞0.05]差异无统计学意义;在围术期严重并发症如肾功能不全行血液透析治疗(2/77比1/71,P＞0.05)、顽固性室性心律失常(1/78比0/72,P＞0.05)、二次开胸探查止血术(5/74比4/68,P＞0.05)的发生率及死亡率(1/71比1/78,P＞0.05)方面差异无统计学意义,手术安全性相似;术后住院时间[(13.6±4.7)d比(15.7±10.9)d,P＞0.05]差异亦无统计学意义.而双极射频消融组心房纤颤消除率高于单极射频消融组(45/27比36/43,x2 =4.342,P ＜0.05),差异有统计学意义.结论风湿性心脏病瓣膜置换术中应用双极射频消融改良迷宫术治疗永久性心房纤颤中远期疗效优于单极射频消融.
목적 비교풍습성심장병판막치환술중응용단겁급쌍겁사빈소융개량미궁술치료영구성심방섬전적중원기료효.방법 청도대학부속의원공위151례풍습성심장판막병합병영구성심방섬전적환자술중동기행판막치환급사빈소융술,기중응용단겁사빈소융79례(단겁조),쌍겁사빈소융72례(쌍겁조).수집소유환자적술전자료,술후수방3～6년,획득환자술후즉각、출원시、3、6개월、1년급수후매년적십이도련심전도(혹24 h동태심전도)급심장초성심동도결과,병기록환자술후병발증급심공능、생활질량개선등정황.비교량조환자심방섬전소제솔(두성심률+결성심률)、수술시간、술후인류량、술후주원시간、위술기엄중병발증급사망솔등.결과 여단겁사빈소융조비교,쌍겁사빈소융조사빈소융시간장[(31.5±3.9) min비(17.1±2.5)min,P＜0.01],차이유통계학의의;이승주동맥조단시간[(61.4 ±20.1)min비(57.0 ±21.6) min,P＞0.05]급체외순배시간[(104.1 ±27.1)min비(93.9±37.9) min,P＞0.05]차이무통계학의의;재위술기엄중병발증여신공능불전행혈액투석치료(2/77비1/71,P＞0.05)、완고성실성심률실상(1/78비0/72,P＞0.05)、이차개흉탐사지혈술(5/74비4/68,P＞0.05)적발생솔급사망솔(1/71비1/78,P＞0.05)방면차이무통계학의의,수술안전성상사;술후주원시간[(13.6±4.7)d비(15.7±10.9)d,P＞0.05]차이역무통계학의의.이쌍겁사빈소융조심방섬전소제솔고우단겁사빈소융조(45/27비36/43,x2 =4.342,P ＜0.05),차이유통계학의의.결론 풍습성심장병판막치환술중응용쌍겁사빈소융개량미궁술치료영구성심방섬전중원기료효우우단겁사빈소융.
Objective To compare the mid-long-term efficacy in the treatment of permanent atrial fibrillation (AF) in rheumatic heart disease using monopolar vs.biopolar radiofrequency ablation during the cardiac valve replacement surgery.Methods 151 patients with rheumatic heart disease and permanent atrial fibrillation underwent modified maze procedure using monopolar or biopolar radiofrequency ablation concomitant the cardiac valve replacement in the affiliated hospital of Qingdao university form January 2007 to December 2010.Seventy-nine of them were given the monopolar radiofrequency ablation (monopolar group),and remaining 72 the biopolar radiofrequency ablation (biopolar group).We collected the perioperative data of the patients,and collected the 12-lead electrocardiogram (ECG) or the dynamic electrocardiogram (24 h Holter),the echocardiography data immediately after the operation,at the time of discharge from hospital,3rd month,6th month,and 1 st year postoperatively,and every year after the operation.We also collected the related complications,the recovery of their cardiac function and life quality and some other useful information.We compared the related indexes including the eliminating rate of the atrial fibrillation (including sinus rhythm and nodal rhythm),operation time,postoperative drainage volume,hospital stay after operation,severe postoperative complications,and the mortality in the two groups.Results The radiofrequency ablation time in the biopolar group was longer than in the monopolar group [(31.5 ±3.9) min vs.(17.1 ±2.5) min,P ＜0.01].There was no significant difference in the ascending aorta clamping time [(61.4 ± 20.1) min vs.(57.0 ± 21.6) min,P ＞ 0.05] and the cardiopulmonary bypass time [(104.1 ±27.1) min vs.(93.9 ±37.9) min,P ＞0.05] between the two groups.In terms of the severe perioperative complications such as the renal insufficiency undergoing hemodialysis (2/77 vs.1/71,P ＞ 0.05),the refractory ventricular arrhythmias (1/78 vs.0/72,P ＞ 0.05),the exploratory thoracotomy for bleeding (5/74 vs.4/68,P ＞ 0.05),and the mortality (1/71 vs.1/78,P ＞ 0.05),the difference between the two groups had no statistical significance,suggesting the safety of the two groups was similar.The postoperative hospital stay [(13.6 ± 4.7) days vs.(15.7 ± 10.9) days,P ＞ 0.05] showed no statistically significant difference.The elimination rate of the atrial fibrillation in the bipolar group was significantly higher than in the monopolar group (27/45 vs.36/43,x2 =4.342,P ＜ 0.05).Conclusion The mid-long-term efficacy in the treatment of the permanent atrial fibrillation in rheumatic heart disease using the biopolar radiofrequency ablation during the cardiac valve replacement surgery is better than the using of the monopolar radiofrequency ablation.