双极射频消融治疗心房纤颤的临床疗效分析

发布时间：2018-05-30 09:56

本文选题：心脏瓣膜置换 + 心房纤颤　；参考：《遵义医学院》2015年硕士论文

【摘要】：目的:对心内直视下瓣膜置换同期行双极射频消融治疗心房纤颤(Atrial fibrillation,AF)的临床疗效进行总结,并分析术前危险因素与术后转复律之间的关系。方法:回顾性分析2009年11月至2014年4月在贵州省人民医院心外科同一手术治疗组行心内直视下瓣膜置换同期行双极AF射频消融术病例219例,其中男53例,女166例;年龄20岁~74岁,平均(46.80±10.03)岁;术前行心电图及超声心动图了解心律及心功能指标。术中行射频消融路线相同,术后定期复查心电图并口服胺碘酮半年,随访半年以上,行心电图出现窦性P波则表明转律成功,根据心电图结果,将患者分为窦性心律(Sinus rhythm,SR)组与非SR组,应用统计学方法比较两组患者术前及术中相关因素是否具有统计学意义。结果:患者术中体外循环时间83 min-243 min,平均(124.80±36.04)min;主动脉阻断时间65 min-204 min,平均(103.86±31.59)min;术中失血量100 ml-1500ml,平均(710.00±281.79)ml;术后机械通气时间1.5 h-167h,平均(12.47±17.42)h;术后住ICU时间12 h-408 h,平均(28.59±33.79)h;术后住院时间6天-41天,平均(14.14±5.05)天;围手术期死亡5.48%(12/219),其中,因术中低心排死亡2例、术后低心排死亡3例、术后恶性心律失常死亡3例、术后多器官功能衰竭死亡3例、术后心脏后壁出血死亡1例。排除围手术期死亡病例,其余207例中,术后二次开胸止血1.45%(3/207)、急性肾衰1.45%(3/207)、切口愈合不良2.90%(6/207)、临时起搏器使用31.88%(67/207)。出院时SR79.00%(173/219),非SR 15.53%(34/219)。出院后随访6~58个月,平均(27.96±15.57)个月,随访率83.57%(173/207),失访率16.43%(34/207),随访期间死亡1.73%(3/173),维持SR 89.02%(154/173),非SR10.98%(19/173)。安装永久起搏器0.58%(1/173),因术后复发室上性心动过速行导管射频消融0.58%(1/173)。随访期间因不明原因猝死1.73%(3/173),其中猝死病例中有2例术后一直为AF心律,1例为SR。单因素分析示左房内径(Left atrial diameter,LAD)、年龄及高血压病是影响术后转复的危险因素(P0.05)。结论:患者在经严格挑选后行心内直视下瓣膜置换同期射频消融治疗AF安全、有效,LAD大、年龄大及高血压病可降低术后转复率。
[Abstract]:Objective: to summarize the clinical efficacy of bipolar radiofrequency ablation (RF) in the treatment of atrial fibrillation with open heart valve replacement, and to analyze the relationship between preoperative risk factors and postoperative cardioversion. Methods: from November 2009 to April 2014, 219 patients (53 males and 166 females) with bipolar AF radiofrequency ablation were retrospectively analyzed in the same surgical group of cardiac surgery in Guizhou Provincial people's Hospital. The average age was 46.80 卤10.03 years. Electrocardiogram (ECG) and echocardiography were performed before operation to understand cardiac rhythm and cardiac function. The same route of radiofrequency ablation was performed during the operation. Electrocardiogram (ECG) was reviewed regularly and amiodarone was taken orally for half a year, followed up for more than half a year. The occurrence of sinus P wave in electrocardiogram showed that the conversion was successful. The patients were divided into two groups: sinus rhythmosis group and non-SR group. The statistical method was used to compare the correlation factors before and during operation between the two groups. Results: the operative time of cardiopulmonary bypass (CPB) was 83 min-243 (mean 124.80 卤36.04 min), aortic occlusion time was 65 min-204 (mean 103.86 卤31.59 min), blood loss during operation was 100ml-1500 ml (mean 710.00 卤281.79 ml), postoperative mechanical ventilation time was 1.5h-167 h (mean 12.47 卤17.42 h), postoperative ICU time was 12 h ~ 408 h (mean 28.59 卤33.79 h). Hospital time 6 days to 41 days, The average death was 14.14 卤5.05 days, and the perioperative death was 5.48% / 219g, in which 2 cases died of low cardiac output, 3 cases died of postoperative low cardiac output, 3 cases died of malignant arrhythmia, 3 cases died of multiple organ failure, and 1 case died of posterior cardiac hemorrhage. Of the 207 patients who died during the perioperative period, the other 207 cases were treated with second thoracotomy and hemostasis (1.45 / 207), acute renal failure (1.45 / 207), bad wound healing (2.90% / 207), temporary pacemaker with 31.88% 67 / 207. At discharge, SR79.00 had 173 / 219s, and non-SR 15.53s 34 / 219g. The follow-up rate was 83.57% (173 / 207m), and the missing rate was 16.43 / 207m. During the follow-up period, the death rate was 1.73 / 173C, maintaining SR 89.02 / 1734 / 173C, not SR10.98 / 173C / 1730.The average follow-up rate was 27.96 卤15.57 months after discharge, and the average follow-up rate was 27.96 卤15.57 months, and the follow-up rate was 16.43 / 207.The death rate during the follow-up period was 1.73 / 173, and maintained SR 89.02 / 173C, not SR10.98 / 173N. Installation of permanent pacemaker 0.58 / 173a, because of recurrent supraventricular tachycardia, radiofrequency catheter ablation of 0.58 / 173. During the follow-up period, 1. 73% of sudden death was due to unknown causes. Among them, 2 cases of sudden death were AF arrhythmia and 1 case was SRS. Univariate analysis showed that left atrial diameter (Left atrial diameterladus), age and hypertension were the risk factors for postoperative recovery (P 0.05). Conclusion: it is safe and effective for patients with AF to undergo open heart valve replacement and radiofrequency ablation after strict selection, and to reduce the rate of postoperative recovery with older age and hypertension.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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