心脏瓣膜置换合并冠状动脉搭桥患者同期行房颤射频消融术的临床应用

发布时间：2018-06-26 06:20

本文选题：冠心病 + 瓣膜病　；参考：《实用医学杂志》2017年18期

【摘要】：目的探讨心脏瓣膜置换、冠状动脉旁路移植和房颤射频消融同期手术治疗复杂心脏病的临床疗效。方法回顾性研究分析2014年7月至2016年12月我院入院冠心病、瓣膜病合并房颤患者164例的临床资料,根据治疗方法的不同分为消融术组和对照组。消融术组患者心脏瓣膜置换合并冠状动脉搭桥同期行房颤射频消融术,对照组患者仅进行瓣膜置换合并冠状动脉搭桥。对比分析两组患者体外循环时间、辅助呼吸时间、ICU入住时间和出院时间,术后随访6个月观察心电图、心脏超声图等指标,对比分析其临床疗效。结果消融术组体外循环时间和辅助呼吸时间长于对照组(P0.05);ICU入住时间和出院时间差异无统计学意义(P0.05);两组患者术后6个月的左心房内径、左心室舒张末容积和射血分数比较差异均有统计学意义(P0.05);消融组术后时和术后6个月时窦性心律转复率分别为70.7%和82.9%,对照组分别为46.3%和19.5%,消融术组明显高于对照组,差异均有统计学意义(P0.05)。结论心脏联合瓣膜置换合并冠状动脉搭桥患者同期行房颤射频消融术能改善患者心功能,提高房颤转复率,随访窦性维持率高,值得临床推广应用。
[Abstract]:Objective to investigate the clinical effects of cardiac valve replacement, coronary artery bypass grafting and radiofrequency ablation of atrial fibrillation (AF) for complex heart disease. Methods the clinical data of 164 patients with coronary heart disease and valvular disease complicated with atrial fibrillation from July 2014 to December 2016 in our hospital were retrospectively analyzed. According to the different treatment methods, the patients were divided into two groups: the ablation group and the control group. Radiofrequency ablation of atrial fibrillation was performed in patients with valvular replacement combined with coronary artery bypass graft, while in control group only valve replacement combined with coronary artery bypass graft was performed. The time of cardiopulmonary bypass, the time of assisted respiration and the time of ICU admission and discharge were compared between the two groups. The electrocardiogram (ECG) and echocardiography were observed in 6 months after operation, and the clinical curative effect was compared and analyzed. Results the time of cardiopulmonary bypass (CPB) and assisted respiration in the ablation group was longer than that in the control group (P0.05), and there was no significant difference in the time of ICU admission and discharge between the two groups (P0.05), and the left atrial diameter of the two groups was 6 months after operation. There were significant differences in left ventricular end-diastolic volume and ejection fraction (P0.05). The sinus rhythm conversion rates were 70.7% and 82.9% in the ablation group and 46.3% and 19.5% in the control group, respectively. The rate of sinus rhythm in the ablation group was significantly higher than that in the control group. The difference was statistically significant (P0.05). Conclusion radiofrequency ablation of atrial fibrillation in patients with combined cardiac valve replacement and coronary artery bypass grafting can improve cardiac function, improve the rate of atrial fibrillation conversion, and follow up high sinus maintenance rate, which is worthy of clinical application.
【作者单位】：山东省济宁市第一人民医院心血管外科;
【分类号】：R654.2

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