瓣膜置换同期不同双极射频消融术式治疗房颤的临床研究

发布时间：2019-05-11 20:11

【摘要】：目的:研究不同双极射频消融术式治疗风心病合并房颤的疗效及安全性。方法:研究分三部分第一部分回顾分析瓣膜置换同期双极射频消融术治疗房颤对心功能恢复影响收集2011年1月至2011年12月新桥医院心外科同一手术组收治的191例瓣膜病合并房颤(AF)患者的临床资料,研究分为对照组(单纯接受瓣膜置换者)和消融组(瓣膜置换同期行双极射频消融者),分别统计两组患者术前、术中资料,及出院前,术后6月,1年,2年心脏超声,心电图及相关并发症,并通过来院随访、电话、书信问卷等途径评估心脏功能,采集数据并进行统计学分析。第二部分回顾分析不同双极射频消融术治疗风心病合并房颤的早期疗效收集2012年5月至2012年12月新桥医院心外科施行瓣膜置换同期双极射频消融手术197例患者的临床资料,研究分为双房消融组行完全双房双极消融;简化右房消融组行左房加简化右房双极消融。收集资料指标同前。第三部分前瞻性研究不同消融术治疗风心病合并房颤的安全性及疗效采用随机、开放、平行对照研究,纳入2012年3月至2013年2月,新桥医院心外科拟接受二尖瓣置换同期双极射频消融的患者73例,随机分为双房消融组和简化右房消融组,术前由第三方告知具体消融术式。收集术前、术中、术后临床资料,以及术后随访3、6、12、18、24个月的心脏超声,心电图及并发症,比较两种方法的疗效。结果:第一部分两组均无手术死亡、心脏破裂、无永久起搏器患者;术后1年、2年LVFS,EF同期消融组均高于对照组;术后1年、2年患者自觉心功能改善率同期消融组均高于对照组。第二部分简化右房消融组与双房消融组术前资料比较均无差异;围手术期并发症无明显差异;术后第一天临时起搏器使用率无明显差异,随访6个月、12个月窦性转复率无明显差异,6个月、12个月心脏超声无明显差异。第三部分术前比较各组资料均无差异;术中,术后简化右房组主动脉阻断时间、消融时间、术中出血量及术后24 h胸腔引流量明显少于对照组。随访结果比较两组患者术后同期窦性转复率和术后心功能改善等差异均无统计学意义;结论:1.瓣膜置换同期双极射频消融术治疗房颤手术安全,窦性转复率明显高于单纯瓣膜置换术,并明显改善术后早、中期心功能。2.回顾性及前瞻性研究均显示,瓣膜置换同期行左房加简化右房消融与完全双房消融治疗房颤术后有相似的早期和中期疗效;瓣膜置换同期行左房加简化右房消融手术较完全双房消融手术主动脉阻断时间、消融时间及术中和术后出血量明显减少。
[Abstract]:Objective: to study the efficacy and safety of different bipolar radiofrequency ablation for rheumatic heart disease complicated with atrial fibrillation. Methods: the first part of the study was divided into three parts: a retrospective analysis of the effects of valvular replacement and bipolar radiofrequency ablation on the recovery of cardiac function in patients with atrial fibrillation. 191 patients treated in the same operation group of Xinqiao Hospital from January 2011 to December 2011 were collected from January 2011 to December 2011. Clinical data of patients with valvular disease complicated with atrial fibrillation (AF), The study was divided into two groups: control group (valve replacement alone) and ablation group (valve replacement patients undergoing bipolar radiofrequency ablation at the same time). The preoperative, intraoperative data and cardiac ultrasound before discharge, 6 months, 1 year and 2 years after operation were counted. Electrocardiogram (ECG) and related complications were evaluated by follow-up, telephone and letter questionnaire, and the data were collected and statistically analyzed. The second part reviews the early efficacy of different bipolar radiofrequency ablation in the treatment of rheumatic heart disease with atrial fibrillation. The clinical data of 197 patients undergoing valve replacement and bipolar radiofrequency ablation in Xinqiao Hospital from May 2012 to December 2012 were collected. The study was divided into two atrium ablation group and complete biatrial bipolar ablation group. The left atrium plus simplified right atrial bipolar ablation was performed in the simplified right atrium ablation group. The data collection index is the same as before. Part III A prospective study on the safety and efficacy of different ablation in the treatment of rheumatic heart disease complicated with atrial fibrillation was included in a randomized, open, parallel controlled study from March 2012 to February 2013, Seventy-three patients undergoing mitral valve replacement and bipolar radiofrequency ablation were randomly divided into two groups: biatrial ablation group and simplified right atrial ablation group. The clinical data were collected before, during and after operation, and the follow-up of 3,6,12,18,24 months after operation were performed to compare the effects of the two methods on echocardiography, ECG and complications. Results: in the first part, there was no operative death, cardiac rupture and no permanent pacemaker in both groups, and the LVFS,EF simultaneous ablation group was higher than the control group at 1 year and 2 years after operation. One year and two years after operation, the improvement rate of conscious cardiac function in the ablation group was higher than that in the control group. In the second part, there was no significant difference in preoperative data between simplified right atrial ablation group and biatrial ablation group, and there was no significant difference in perioperative complications. There was no significant difference in the utilization rate of temporary pacemaker on the first day after operation. There was no significant difference in sinus recovery rate at 6 months and 12 months after follow-up, but there was no significant difference in echocardiography at 6 months and 12 months after operation. In the third part, there was no difference in the data of each group before operation, and the aortic occlusion time, ablation time, intraoperative bleeding volume and thoracic drainage 24 hours after operation in the right atrium group were significantly lower than those in the control group. There was no significant difference in sinus recovery rate and improvement of cardiac function between the two groups in the same period after operation. Conclusion: 1. Valve replacement combined with bipolar radiofrequency ablation is safe in the treatment of atrial fibrillation. The sinus recovery rate is significantly higher than that of valve replacement alone, and the cardiac function in the early and middle stage after operation is significantly improved. 2. Retrospective and prospective studies showed that left atrium plus simplified right atrium ablation was similar to complete biatrial ablation in the treatment of atrial fibrillation. Compared with complete biatrial ablation, the aortic cross-clamping time, ablation time and intraoperative and postoperative bleeding volume were significantly decreased in valve replacement with left atrium plus simplified right atrium ablation.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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