心脏瓣膜置换、房颤射频消融同期行左心耳结扎的疗效分析
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摘要
目的总结应用心脏瓣膜置换、房颤射频消融同期行左心耳结扎手术治疗的临床疗效。方法研究分析2013年7月至2017年6月我院入院心房纤颤合并瓣膜病患者430例患者,根据治疗方法的不同分为对照组和左心耳结扎组,每组215例。左心耳结扎组患者行心脏瓣膜置换、房颤射频消融同期行左心耳结扎,对照组患者仅进行瓣膜置换术及房颤射频消融术。对比分析两组手术相关指标及术后随访期内房颤复发率、患者出血事件及栓塞事件发生率等指标,分析其临床疗效。结果左心耳结扎组与对照组比较手术时间和体外循环时间差异有统计学意义(P <0.05),平均时间分别延长8.0 min和6.2 min,呼吸机辅助呼吸时间、ICU入住时间、二次开胸发生率及住院院时间及术后随访期内出血事件发生率差异无统计学意义(P> 0.05);两组患者出血事件发生率比较差异无统计学意义(P> 0.05),但左心耳结扎组患者栓塞率比较差异有统计学意义(P <0.05)。结论心脏联合瓣膜置换、房颤射频消融同期行左心耳结扎的手术方式是安全的,可以降低患者的栓塞率,提高患者生存质量,值得临床推广应用。
Objective To summarize the clinical efficacy of cardiac valve replacement and radiofrequency ablation of atrial fibrillation in the treatment of left atrial appendage. Methods The clinical data of 430 patients with valvular disease and atrial fibrillation admitted to our hospital from July 2013 to June 2017 were analyzed.According to different treatment methods,the left atrial appendage ligation group and the control group were 215 patients for each. Patients with left atrial appendage ligation underwent cardiac valve replacement,radiofrequency ablation of atrial fibrillation and left atrial appendage ligation. The control group only underwent valve replacement and radiofrequency ablation of atrial fibrillation. The indexes of surgery were compared and the recurrence rate of atrial fibrillation,the incidence of bleeding and the incidence of embolic events during the follow-up period were analyzed. The clinical efficacy was analyzed. Results Compared with the control group,the left atrial appendage ligation group had a difference in operative time and extracorporeal circulation time(P < 0.05),and the mean time was extended by 8.0 min and 6.2 min respectively. The ventilator assisted breathing time,ICU stay time,and secondary thoracotomy rate. There was no statistically significant difference in the incidence of bleeding events between the hospital and the follow-up period(P > 0.05). There was no significant difference in the left atrial diameter,left ventricular end-diastolic volume,and ejection fraction between the two groups(P > 0.05). There was no significant difference in the incidence of bleeding events between the two groups(P > 0.05),but the embolization rate of the left atrial appendage ligation group was statistically significant(P < 0.05). Conclusion Cardiac combined with valve replacement,radiofrequency ablation of atrial fibrillation and left atrial appendage ligation are safe,which can reduce the embolization rate of patients and improve the quality of life of patients. It is worthy of clinical application.
Objective To summarize the clinical efficacy of cardiac valve replacement and radiofrequency ablation of atrial fibrillation in the treatment of left atrial appendage. Methods The clinical data of 430 patients with valvular disease and atrial fibrillation admitted to our hospital from July 2013 to June 2017 were analyzed.According to different treatment methods,the left atrial appendage ligation group and the control group were 215 patients for each. Patients with left atrial appendage ligation underwent cardiac valve replacement,radiofrequency ablation of atrial fibrillation and left atrial appendage ligation. The control group only underwent valve replacement and radiofrequency ablation of atrial fibrillation. The indexes of surgery were compared and the recurrence rate of atrial fibrillation,the incidence of bleeding and the incidence of embolic events during the follow-up period were analyzed. The clinical efficacy was analyzed. Results Compared with the control group,the left atrial appendage ligation group had a difference in operative time and extracorporeal circulation time(P < 0.05),and the mean time was extended by 8.0 min and 6.2 min respectively. The ventilator assisted breathing time,ICU stay time,and secondary thoracotomy rate. There was no statistically significant difference in the incidence of bleeding events between the hospital and the follow-up period(P > 0.05). There was no significant difference in the left atrial diameter,left ventricular end-diastolic volume,and ejection fraction between the two groups(P > 0.05). There was no significant difference in the incidence of bleeding events between the two groups(P > 0.05),but the embolization rate of the left atrial appendage ligation group was statistically significant(P < 0.05). Conclusion Cardiac combined with valve replacement,radiofrequency ablation of atrial fibrillation and left atrial appendage ligation are safe,which can reduce the embolization rate of patients and improve the quality of life of patients. It is worthy of clinical application.
引文
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[10]JOSHIBAYEV S,BOLATBEKOV B.Early and long-term outcomes and quality of life after concomitant mitral valve surgery,left atrial size reduction,and radiofrequency surgical ablation of atrial fibrillation[J].Anatol J Cardiol,2016,16(10):797-803.
[11]李师亮,张凯伦,蒋雄刚,等.大左室心脏瓣膜病的外科治疗[J].临床心血管病杂志,2010,26(3):190-192.
[12]OUEIDA F,ELAWADY M A,ESKANDER K.Radiofrequency ablation of atrial fibrillation during mitral valve surgery[J].Asian Cardiovasc Thorac Ann,2014,22(7):807-810.
[13]JOSHIBAYEV S D,BOLATBEKOV B A.One-stage application of mitral valve correction,surgical radiofrequency ablation and left atrial atrioplasty[J].Vestn Ross Akad Med Nauk,2015,(3):279-285.
[2]ZIPSE M M,NGUYEN D T.Ablation of atrial fibrillation in a patient with a mechanical mitral valve[J].Card Electrophysiol Clin,2016,8(1):155-159.
[3]JOSHIBAYEV S,BOLATBEKOV B.Early and long-term outcomes and quality of life after concomitant mitral valve surgery,left atrial size reduction,and radiofrequency surgical ablation of atrial fibrillation[J].Anatol J Cardiol,2016,16(10):797-803.
[4]刘艳,彭淑华,付晓丽.冠状动脉旁路移植同期行心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床观察[J].实用医学杂志,2016,32(16):2686-2688.
[5]陈月云,王星,程光华,等.老年退行性心脏瓣膜病患者免疫炎症因子的观察[J].临床心血管病杂志,2011,27(5):371-373.
[6]张正升,张申,吴联合,等.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[J].实用医学杂志,2017,33(18):3077-3080.
[7]薛明,梁贵友,刘达兴,等.心脏瓣膜病合并巨大左心室51例术后近中期疗效观察[J].中国胸心血管外科临床杂志,2015,22(2):178-179.
[8]KASEMSARN C,LERDSOMBOON P,SUNGKAHAPHONGV,et al.Left atrial reduction in modified maze procedure with concomitant mitral surgery[J].Asian Cardiovasc Thorac Ann,2014,22(4):421-429.
[9]MACDONALD DR,MARUTHAPPU M,NAGENDRAN M.How effective is microwave ablation for atrial fibrillation during concomitant cardiac surgery?[J].Interact Cardiovasc Thorac Surg,2012,15(1):122-127.
[10]JOSHIBAYEV S,BOLATBEKOV B.Early and long-term outcomes and quality of life after concomitant mitral valve surgery,left atrial size reduction,and radiofrequency surgical ablation of atrial fibrillation[J].Anatol J Cardiol,2016,16(10):797-803.
[11]李师亮,张凯伦,蒋雄刚,等.大左室心脏瓣膜病的外科治疗[J].临床心血管病杂志,2010,26(3):190-192.
[12]OUEIDA F,ELAWADY M A,ESKANDER K.Radiofrequency ablation of atrial fibrillation during mitral valve surgery[J].Asian Cardiovasc Thorac Ann,2014,22(7):807-810.
[13]JOSHIBAYEV S D,BOLATBEKOV B A.One-stage application of mitral valve correction,surgical radiofrequency ablation and left atrial atrioplasty[J].Vestn Ross Akad Med Nauk,2015,(3):279-285.