【摘要】 目的对比研究抗心律失常药物、导管介入消融和外科射频消融3种治疗方式治疗风湿性心脏病合并心房颤动的临床效果。方法回顾性分析2004年7月～2005年7月于北京安贞医院确诊为风湿性瓣膜病合并心房颤动并施行瓣膜置换术的患者96例,根据AF治疗方式不同分为3组:A组28例单纯抗心律失常药物治疗,B组24例行术后导管介入消融术,C组44例行射频消融迷宫手术,术后随访12个月。结果 3组患者之间瓣膜置换数、心脏自动复跳例数、起搏器植入例数、LVEF以及30 d死亡人数之间差异无统计学意义(均P>0.05)。A组术后1个月1例(3.6%)患者死亡。体外循环(C PB)时间及主动脉阻断时间A、C组明显低于B组(均P<0.05),A、C组之间差异无统计学意义(均P>0.05)。B组住院天数明显多于A、C组,C组多于A组,差异均有统计学意义(均P<0.05)。术后心室率A组明显高于B、C组,差别有统计学意义(均P=0.00),B、C组之间差别无统计学意义(P<0.05)。术后即刻、出院时、术后3个月、术后6个月、术后12个月窦性心律转复人数比较发现,B、C两组窦性心律维持率均较高,尤其是C组,疗效满意,各组之间差别均有统计学意义(均P<0.05)。手术并发症主要有心包积液、胸腔积液和呼吸功能不全等,C组心包积液发生率高于A、B组,差别有统计学意义(均P<0.05)。结论瓣膜置换术合并进行射频消融术对于风湿性心脏瓣膜病合并心房颤动的治疗效果优于单纯抗心律失常药物或导管介入消融治疗,能成功扭转并稳定窦性心律。更多还原

【Abstract】 【Objective】 To research the clinical outcomes of the three approaches in patients with atrial fibrillation(AF) of rheumatic heart disease(RHD).【Methods】 All total of 96 patients with AF of RHD admitted to Beijing Anzhen Hospital between July 2004 and July 2005 were included in this retrospective study and were classified according to treatment method..All cases underwent heart valve replacement.Group A(n =28) only used anti-arrhythmia agent.Group B(n =24) underwent catheter ablation.Group C(n =44) underwent radiofrequency ablation Maze procedure.All cases were followed up for 12 months.【Results】 The difference of number of prosthetic valve,cases of the heart beat recovered automatically,cases of pacemaker implantation,LVEF and number of fatality in 30 days among the three groups had no statistical significance(All P >0.05).One patient in group A was dead in 30 days after operation.The duration of cardiopulmonary bypass(CPB) and aorta cross-clamped in group A and C were less than that in group B(All P =0.00),but there was no significant difference between group A and C(Both P >0.05).The number of inpatient hospital days of group C was greater than group A,but was lesser than group B(All P <0.05).The ventricular rate after operation of group A was significantly greater than group B and C(P =0.00).The maintenance of sinus rhythm of group C was significantly better than group A and B(All P <0.05).The treatment effect was satisfactory.The surgical complications mainly included pericardial effusion,pleural effusion and respiratory insufficiency.The incidence of pericardial effusion in group C was higher than group A and B(All P <0.05).【Conclusions】 Radiofrequency ablation Maze procedure is safe and effective for treatment of cardioversion of AF and maintenance of sinus rhythm in RHD patients.The treatment effect is better than anti-arrhythmia agent and/or catheter ablation.更多还原