二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的療效分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

鄔曉臣 ,  張近寶 , 歐陽輝 , 岳琴 , 辛梅 , 李運明 , 辛東

;

Corresponding?author：

張近寶, Email: zhangjb1@126.com

Keywords：

風濕性心臟病; 射頻消融; 心房顫動

DOI：

10.7507/1007-4848.20140237

Video：

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目的分析二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的臨床效果。方法 2009年6月至2012年6月成都軍區總醫院共收治風濕性二尖瓣病變合并心房顫動患者200例，其中男80例、女120例，年齡37～63（48.3±11.0）歲。根據是否同期行雙極射頻消融術將患者分為兩組，試驗組（n=100）患者瓣膜置換術同期行雙極射頻消融術，對照組（n=100）單純行瓣膜置換術。結果試驗組體外循環時間和主動脈阻斷時間較對照組均顯著延長［（64.6±12.7）min vs.（60.8±10.8）min，P=0.024；（55.3±12.1）min vs.（49.8±10.5）min，P=0.001］，住院費用顯著增加［（11.2±3.5）萬元vs.（9.8±2.2）萬元，P=0.001］，死亡率差異無統計學意義（2% vs.1%，P=0.561）。試驗組在術畢、術后１年時的心房顫動轉復率均顯著高于對照組（82.0% vs.27.0%，72.9% vs.9.6%，P<0.05）。結論二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動患者是安全、有效的。

Citation： 鄔曉臣, 張近寶, 歐陽輝, 岳琴, 辛梅, 李運明, 辛東. 二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的療效分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 827-829. doi: 10.7507/1007-4848.20140237 Copy

1.	Sims JB, Roberts WC. Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis(with or without associated mitral regurgitation). Am J Cardiol, 2006, 97(7):1035-1038.
2.	王輝山, 汪曾煒, 李新民, 等.雙極射頻消融迷宮術后同步電復律治療心房顫動.中國胸心血管外科臨床雜志, 2011, 18(4):359-361.
3.	陳林, 肖穎彬, 肖娟, 等.不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用.中國胸心血管外科臨床雜志, 2012, 19(4):371-375.
4.	Chaiyaroj S, Ngarmukos T, Lertsithichai P. Predictors of sinus rhythm after radiofrequency maze and mitral valve surgery. Asian Cardiovasc Thorac Ann, 2008, 16(4):292-297.
5.	熊克品, 錢紅波, 楊小龍, 等.心臟機械瓣膜置換術后抗凝治療的安全性.中國胸心血管外科臨床雜志, 2012, 19(1):88-89.
6.	肖錫俊, 朱喜亮, 唐紅, 等.二尖瓣置換術后患者遠期超聲心動圖特征及其臨床意義.中國胸心血管外科臨床雜志, 2013, 20(2):144-147.
7.	肖錫俊, 袁宏聲, 唐紅, 等.二尖瓣置換時采用鹽水沖洗的射頻改良迷宮手術治療心房顫動.中華心律失常學雜志, 2006, 10(5):342-344.
8.	張培德, 王巍.心房顫動與心房纖維化的聯系.中國胸心血管外科臨床雜志, 2011, 18(6):561-564.
9.	Gillinov AM, McCarthy PM. Atricure bipolar radiofrequency clamp for intraoperative ablation of atrial fibrillation. Ann Thorac Surg, 2002, 74(6):2165-2168.
10.	盂旭, 王堅剛.心內直視下射頻消融術治療心房顫動.中華胸心血管外科雜志, 2005, 4(1):247-248.
11.	符竣, 王波, 陶涼, 等.兩種不同射頻消融方式治療風濕性心瓣膜病合并永久性心房顫動的療效比較.中國胸心血管外科臨床雜志, 2013, 20(3):304-307.
12.	Beukema WP, Sie HT, Misier AR, et al. Predictive factors of susta-ined sinus rhythm and recurrent atrial fibrillation after a radiofrequency modified Maze procedure. Eur J Cardiothorac Surg, 2008, 34(4):771-775.
13.	Fasol R, Mdinhart J, Binder T. A modified and simplified radiofre-quency ablation in patients with mitral valve disease. J Thorac Cardiovasc Surg, 2005, 129(1):215-217.
14.	楊嵩, 張希, 唐白云, 等.永久性心房顫動外科雙極射頻消融術的效果.中國胸心血管外科臨床雜志, 2012, 19(3):254-257.
15.	Kim KC, Cho KR, Kim YJ, et al. Long-term results of the Cox-Maze Ⅲ procedure for persistent atrial fibrillation associated with rheumatic mitral valve disease:10 year experience. Eur J Cardiothorac Surg, 2007, 31(2):261-266.
16.	Santarpino G, Rubino AS, Onorati F, et al. Atrial fibrillation ablation induces reverse remodelling and impacts cardiac function. Minerva Cardioangiol, 2011, 59(1):17-29.

1. Sims JB, Roberts WC. Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis(with or without associated mitral regurgitation). Am J Cardiol, 2006, 97(7):1035-1038.
2. 王輝山, 汪曾煒, 李新民, 等.雙極射頻消融迷宮術后同步電復律治療心房顫動.中國胸心血管外科臨床雜志, 2011, 18(4):359-361.
3. 陳林, 肖穎彬, 肖娟, 等.不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用.中國胸心血管外科臨床雜志, 2012, 19(4):371-375.
4. Chaiyaroj S, Ngarmukos T, Lertsithichai P. Predictors of sinus rhythm after radiofrequency maze and mitral valve surgery. Asian Cardiovasc Thorac Ann, 2008, 16(4):292-297.
5. 熊克品, 錢紅波, 楊小龍, 等.心臟機械瓣膜置換術后抗凝治療的安全性.中國胸心血管外科臨床雜志, 2012, 19(1):88-89.
6. 肖錫俊, 朱喜亮, 唐紅, 等.二尖瓣置換術后患者遠期超聲心動圖特征及其臨床意義.中國胸心血管外科臨床雜志, 2013, 20(2):144-147.
7. 肖錫俊, 袁宏聲, 唐紅, 等.二尖瓣置換時采用鹽水沖洗的射頻改良迷宮手術治療心房顫動.中華心律失常學雜志, 2006, 10(5):342-344.
8. 張培德, 王巍.心房顫動與心房纖維化的聯系.中國胸心血管外科臨床雜志, 2011, 18(6):561-564.
9. Gillinov AM, McCarthy PM. Atricure bipolar radiofrequency clamp for intraoperative ablation of atrial fibrillation. Ann Thorac Surg, 2002, 74(6):2165-2168.
10. 盂旭, 王堅剛.心內直視下射頻消融術治療心房顫動.中華胸心血管外科雜志, 2005, 4(1):247-248.
11. 符竣, 王波, 陶涼, 等.兩種不同射頻消融方式治療風濕性心瓣膜病合并永久性心房顫動的療效比較.中國胸心血管外科臨床雜志, 2013, 20(3):304-307.
12. Beukema WP, Sie HT, Misier AR, et al. Predictive factors of susta-ined sinus rhythm and recurrent atrial fibrillation after a radiofrequency modified Maze procedure. Eur J Cardiothorac Surg, 2008, 34(4):771-775.
13. Fasol R, Mdinhart J, Binder T. A modified and simplified radiofre-quency ablation in patients with mitral valve disease. J Thorac Cardiovasc Surg, 2005, 129(1):215-217.
14. 楊嵩, 張希, 唐白云, 等.永久性心房顫動外科雙極射頻消融術的效果.中國胸心血管外科臨床雜志, 2012, 19(3):254-257.
15. Kim KC, Cho KR, Kim YJ, et al. Long-term results of the Cox-Maze Ⅲ procedure for persistent atrial fibrillation associated with rheumatic mitral valve disease:10 year experience. Eur J Cardiothorac Surg, 2007, 31(2):261-266.
16. Santarpino G, Rubino AS, Onorati F, et al. Atrial fibrillation ablation induces reverse remodelling and impacts cardiac function. Minerva Cardioangiol, 2011, 59(1):17-29.

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二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的療效分析

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