CAJ | 학술논문

目的：分析二尖瓣机械瓣膜置换术同期实施双极射频消融术治疗风湿性心脏瓣膜病合并心房纤颤的临床效果。方法选取2011年1月—2013年6月在赣南医学院第一附属医院就诊的风湿性心脏瓣膜病合并心房纤颤患者54例，根据治疗方法不同分为观察组和对照组，每组27例。观察组患者采用二尖瓣机械瓣膜置换术同期行双极射频消融术，对照组患者行二尖瓣机械瓣膜置换术。比较两组患者体外循环时间、主动脉阻断时间、辅助呼吸时间、入住ICU时间及住院时间，随访6个月时左心室射血分数、左心房内径及左心室舒张末期内径，术后和随访截止时心房纤颤转复情况。结果观察组患者体外循环时间及主动脉阻断时间均长于对照组（ P＜0.05）；两组患者辅助呼吸时间、入住ICU时间、住院时间比较，差异无统计学意义（P＞0.05）。观察组患者随访6个月时左心房内径、左心室舒张末期内径均短于对照组（P＜0.05）；两组患者左心室射血分数比较，差异无统计学意义（P＞0.05）。两组患者均顺利完成手术，无死亡病例。观察组患者21例（77.8％）术后转复为窦性心律，随访截止时20例（74.1％）转复为窦性心律；对照组患者6例（22.2％）术后转复为窦性心律，随访截止时4例（14.8％）转复为窦性心律；观察组患者术后及随访截止时心房纤颤转复率高于对照组（ P＜0.05）。结论二尖瓣机械瓣膜置换术同期实施双极射频消融术可明显改善风湿性心脏瓣膜病合并心房纤颤患者的心功能，提高心房纤颤转复率，且不增加辅助呼吸时间和住院时间。
목적：분석이첨판궤계판막치환술동기실시쌍겁사빈소융술치료풍습성심장판막병합병심방섬전적림상효과。방법선취2011년1월—2013년6월재공남의학원제일부속의원취진적풍습성심장판막병합병심방섬전환자54례，근거치료방법불동분위관찰조화대조조，매조27례。관찰조환자채용이첨판궤계판막치환술동기행쌍겁사빈소융술，대조조환자행이첨판궤계판막치환술。비교량조환자체외순배시간、주동맥조단시간、보조호흡시간、입주ICU시간급주원시간，수방6개월시좌심실사혈분수、좌심방내경급좌심실서장말기내경，술후화수방절지시심방섬전전복정황。결과관찰조환자체외순배시간급주동맥조단시간균장우대조조（ P＜0.05）；량조환자보조호흡시간、입주ICU시간、주원시간비교，차이무통계학의의（P＞0.05）。관찰조환자수방6개월시좌심방내경、좌심실서장말기내경균단우대조조（P＜0.05）；량조환자좌심실사혈분수비교，차이무통계학의의（P＞0.05）。량조환자균순리완성수술，무사망병례。관찰조환자21례（77.8％）술후전복위두성심률，수방절지시20례（74.1％）전복위두성심률；대조조환자6례（22.2％）술후전복위두성심률，수방절지시4례（14.8％）전복위두성심률；관찰조환자술후급수방절지시심방섬전전복솔고우대조조（ P＜0.05）。결론이첨판궤계판막치환술동기실시쌍겁사빈소융술가명현개선풍습성심장판막병합병심방섬전환자적심공능，제고심방섬전전복솔，차불증가보조호흡시간화주원시간。
Objective To investigate the clinical effect of simultaneous mitral valve replacement and bipolar radiofrequency ablation on rheumatic heart valve diseases complicated with atrial fibrillation.Methods From January 2011 to June 2013, a total of 54 patients with rheumatic heart valve diseases and atrial fibrillation were selected in the First Affiliated Hospital of Gannan Medical College, and they were divided into control group and observation group according to therapeutic methods, each of 27 cases.Patients of control group were given simultaneous mitral valve replacement only, while patients of observation group were given simultaneous mitral valve replacement and bipolar radiofrequency ablation.Cardiopulmonary bypass time, aorta cross-clamping time, assisted respiration time, ICU stays and hospital stays, LVEF, LAD and LVEDD at the sixth month of follow-up, recovery rate of atrial fibrillation after surgery and at the end of follow-up were compared between the two groups.Results Cardiopulmonary bypass time and aorta cross-clamping time of observation group were statistically significantly longer than those of control group (P<0.05); while no statistically significant differences of assisted respiration time, ICU stays or hospital stays was found between the two groups ( P >0.05 ) . LAD and LVEDD of observation group were statistically significantly shorter than those of control group ( P<0.05 ) at the sixth month of follow-up; while no statistically significant differences of LVEF was found between the two groups ( P>0.05) .Patients of both groups successfully completed the surgery, no one died.The recovery rate of atrial fibrillation of observation group was 77.8% after surgery, was statistically significantly higher than that of control group of 22.2% (P<0.05); the recovery rate of atrial fibrillation of observation group was 74.1%at the end of follow-up, was also statistically significantly higher than that of control group of 14.8% (P<0.05).Conclusion Simultaneous mitral valve replacement and bipolar radiofrequency ablation can obviously improve the cardiac function and recovery rate of atrial fibrillation of patients with rheumatic heart valve diseases and atrial fibrillation, without increasing the assisted respiration time or hospital stays.