瓣膜替换术后心房颤动的变化（附144例分析）

THE OUTCOME OF ATRIAL FIBRILLATION AFTER VALVE REPLACEMENT AND CONSIDERATION OF ITS FURTHER SURGICAL MANAGEMEN──CLINICAL. ANALYSIS OF 144 CASES

本文以１９８４年５月至１９９１年１２月间行机械瓣膜替换的１４４例风湿性心脏病为基础，分析心房颤动（房颤）的发生及术后的演变与有关因素的关系。１４４例中二尖瓣病变１２４例，二尖瓣与主动脉瓣联合病变２０例；术前合并房颤者１０８例（７５％）。分析表明：年龄及左房直径大者易发生房颤，术前为窦性心律及术后维持２周以上者，其左房直径均值均＜５３ｍｍ；术后早期存活的１０２例房颤患者中，部分病例房颤一度消失，但于２周内８９例（８６．４％）又转为房颤；术中应用电击除颤复跳对术后房颤的消失有一定作用；左房血栓患者电击除颤后房颤的再现时间比无血栓者为早。瓣膜替换术后虽然瓣膜功能的矫正使血液动力学得到改善，但根据本文统计，术后房颤仍不能得到根除，为了提高合并房颤的瓣膜疾病的手术疗效，必须在替换瓣膜的同时寻求一种针对房颤的有效附加方法。

The related factors of the occurrence of atrial fibrillation (AF) and its postoperative outcome in 144 cases of mechanical valve replacement, operated from May 1984 to Dec. 1991, were analyzed. Among them, 124 were mitral valvular disease (MS+MI), 20 mitral and aortic valvular disease, and 108 complicated with AF preoperatively (75%). More AF occurred in aged patient having larger left atrial diameter. The mean left atrial diameter was less than 53 mm in those patients having sinus rhythm preoperatively and pertained normal rhythm before discharging. In the 102 survived cases with AF preoperatively, the AF disappeared temporarily in most of them, but it reappeared in 88 cases within 2 weeks (86. 3%). Electrical defibrillation during operation for cardiac resuscitation had some effect on postoperative atrial fibrillation. In the group having left atrial thrombus, the time of reappearance of AF postoperatively was earlier. Even though the hemodynamics could be improved after valve replacement, AF could not be corrected by the related surgical procedure. For achieving better surgical result of cardiac valvular diseases, additional surgical procedure directing at resolution of the complicating AF should be considered.