【作者】 刘勇；

【导师】 刘季春；

【作者基本信息】 南昌大学 ， 心胸外科， 2018， 硕士

【摘要】 目的:本研究主要探讨瓣膜手术同期行射频消融术治疗房颤的临床疗效分析。方法:选取2010年6月-2011年1月我院心胸外科住院治疗患者共37例,其中16例行瓣膜手术同期行射频消融术治疗为射频消融组,另21例行单纯瓣膜手术治疗为对照组。对照组中,男性7例,女性14例,平均年龄49.8±7.1岁;其中二尖瓣替换术10例,主动脉瓣替换术7例,二尖瓣+主动脉瓣替换术4例;房颤病史时长平均为56.8±12.8月;心功能(NYHA)Ⅱ级3例,心功能(NYHA)Ⅲ级14例,心功能(NYHA)Ⅳ级4例;左心室射血分数(EF)平均为39.8±5.0%;左房内径平均为68.8±9.9 mm,其中左心房有附壁血栓7例。观察组中,男性5例,女性11例,平均年龄47.6±6.3岁;其中二尖瓣替换术8例,主动脉瓣替换术5例,二尖瓣+主动脉瓣替换术3例;房颤病史平均为49.5±11.5月,心功能(NYHA)Ⅱ级3例,心功能(NYHA)Ⅲ级11例,心功能(NYHA)Ⅳ级2例,左心室射血分数(EF)平均为42.4±5.6%;左房内径平均为64.3±9.4 mm,其中左心房有附壁血栓5例。术后3个月、1年行心脏超声检查并与术前进行对比研究,比较两种手术方法的早期治疗效果。结果:对照组病例主动脉阻断平均时间为65.9±17.3 min,体外循环平均时间为142.8±32.6 min,手术平均时间为225.6±53.7 min,术中平均出血量为357.4±92.6 ml。观察组病例射频消融平均时间为23.4±5.8 min,主动脉阻断平均时间为76.5±17.3 min,体外循环平均时间为130.2±28.6 min,手术平均时间为210.8±43.4 min,术中平均出血量为339.1±85.2 ml。16例术后AF均消失,术后复转AF 3例,出院时维持窦性心律13例,成功率81.3%。无穿孔、出血、房室阻滞及各种心律失常等术后并发症发生,无死亡病例出现。观察组1年后心功能明显优于对照组。对照组和观察组中患者在主动脉阻断时间、体外循环时间、手术时间和术中出血指标上的差异经统计学分析无统计学意义(P>0.05)。结论:RHD合并AF瓣膜手术同期行Atricure双极RFA手术治疗能有效改善患者远期术后心功能,且该方法安全、省时、效果好。更多还原

【Abstract】 Objective : To investigate the effectiveness of atricure TM ablation in the patients with atrial fibrillation(AF)underwent valvular surgery.Methods: We chosen 37 patients with atrial fibrillation in Cardio Surgery in our hospital from June 2010 to January 2011,16 patients underwent radiofrequency ablation,another 21 cases dealed with valvular surgery.The control group contains 7men and 14 women,the average age was 49.8 ± 7.1 years old.It contains 10 mitral valve replacements,7 aortic valve replacements and 4 double valve replacements.The average time of disease was 56.8±12.8 months.It contains 3 NYHA II patients,14 NYHA III patients,and 4 NYHA IV patients.The average EF was 39.8±5.0%.The average left atrial diameter was 68.8 ± 9.9 mm.It contains 7 cases mural thrombus.The observation group contains 5 men and 11 women,the average age was47.6 ± 6.3 years old.It contains 8 mitral valve replacements,5 aortic valve replacements and 3 double valve replacements.The average time of disease was 49.5±11.5 months.It contains 3 NYHA II patients,11 NYHA III patients,and 2 NYHA IV patients.The average EF was 42.4±5.6%.The average left atrial diameter was64.3 ± 9.4 mm.It contains 5 cases mural thrombus.The echocardiography was performed and compared the 3rd month and 1st year after the operation with before the operation.The effect of the early treatment of the two surgical methods was compared.Results:Heart valve replacement and concomitant bipolar radiofrequency for atrial fibrillation was safe and there were no complications such as perforation and bleeding,no atrioventricular block and all kinds of arrhythmia,no death cases occurred.The average time of the aortic cross-clamp time,bypass time,operation time and amount of bleeding in the control group were 65.9±17.3 min,142.8±32.6min,225.6±53.7 min and 357.4±92.6 ml,respectively.The average time of radiofrequency ablation time,the aortic cross-clamp time,bypass time,operation time and amount of bleeding in the observation group were 23.4±5.8 min,76.5±17.3 min,130.2±28.6 min,210.8± 43.4 min and 339.1±85.2 ml,respectively.In the observationgroup 16 cases record sinus rhythm,13 cases record sinus rhythm,3 remained in AF postoperatively.The heart function of the observation group at the 1st year after the operation was better than observation group before the operation.Through the comparative analysis of statistics,the two groups in the aortic cross-clamp time,bypass time,operation time,amount of bleeding were no statistically significant(P>O.05).Conclusion: RFA for RHD with AF is safety,time-saving and it can achieve good results and improve postoperative cardiac function in patients.更多还原