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风湿性心脏病手术前后房颤发生率及其预后分析 被引量:21

Preoperative and postoperative incidence of atrial fibrillation and its prognosis in patients with rheumatic heart valve disease
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摘要 目的:分析风湿性心脏病(风心病)手术前后房颤(Af)发生率及其预后。方法:回顾性分析1992~1994年561例风心病手术患者Af的发病率、死亡率及其相关因素。根据患者的病史、超声心动图、X线胸片、心电图、手术资料和术后6~40个月的随访结果进行分析。结果:风心病的Af发生率为65.24%,其中二尖瓣病变为75.26%,高于主动脉瓣病变的发生率(15.38%)。二尖瓣手术后Af持续的患者占93.89%,自然转为窦律者6.10%,术前窦律术后变为Af的占15.71%。二尖瓣手术后半年随访Af的发生率为80.09%。二尖瓣术后半年有28例行直流电转复,成功率为82.14%,与心胸比值、心衰持续时间、左房容积和左室容积有关。风心病中Af组的左房血栓检出率和脑栓塞发生率分别为7.65%和5.73%,显著高于窦律组。Af组的围术期和随访期死亡率分别为5.74%和3.28%,与窦律组无显著差别。结论:风心病伴慢性Af患者的术后Af自然转复律低,有80%经治疗后仍为Af持续状态。Af患者的血栓形成和栓塞发生率明显增高,心脏扩大和左心功能减退则影响Af的预后。 Objective: To analyse the preoperative and postoperative incidence of atrial fibrillation (Af) and its prognosis in patients with rheumatic heart valve disease (RHD).Methods: Between 1992 and 1994, 561 consecutive operative cases of RHD were studied retrospectively for the incidence and prognosis of Af. For this study, we reviewed operative notes, clinical histories, and laboratory investigations including electrocardiograms, echocardiograms, and Xray film data. The followup ranged from 6 to 40 momths after operation. Results: The prevalence of Af was 65.24% in patients with RHD, The incidence was 75.26% in mitral valve disease and 15.38% in aortic valve disease respectively(P<0.0001). postoperatively, Af was present in 15.71% of patients with preoperative sinus rhythm (SR), and 93.8% of patients with preoperative Af. SR was present in 6.10% of patients with preoperative Af. At 6 months followup, the prevalence of Af was still 80.09% in patients with preoperative Af. Cardioversion was performed in 28 cases within 6 months after operation, and successful rate was 82.14%. Cardiothoracic ratio, duration of heart failure, left atrial (LA) and left ventricular (LV) size were the significant predictors affecting Af cardioversion. The LA Thromosis (7.65% ) and cerebral embolism (5.73%) in Af group were higher than those in sinus rhythm group significantly. Comparing patients with preoperative Af to those with SR, we found no significant difference in early or late mortality.Conclusion: The spontaneous cardioversion rate of Af after operation is very low in patients with RHD. The prevalence of Af is still 80.09% postoperatively, and cardiomegaly or LV dysfunction influences its prognosis. The prevalence of LA thrombsis and cerebral embolism is significant higher in patients with Af. 
出处 《第二军医大学学报》 CAS CSCD 北大核心 1997年第S1期89-91,共3页 Academic Journal of Second Military Medical University
关键词 风湿性心脏病 心房颤动 预后 rheumatic heart disase atrial fibrillation prognosis
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