同期行修补和迷宫手术治疗成人房间隔缺损合并心房颤动的疗效分析

Clinical analysis of Cox-maze procedure for adult patients with atrial septal defect combined with atrial fibrillation

目的评估迷宫手术对房间隔缺损合并心房颤动(房颤)患者的治疗效果。方法 986例40岁以上房间隔缺损术患者,根据术前是否存在房颤分为三组。A组为不合并房颤患者(窦性心律),共619例;B组为合并房颤并同期进行迷宫手术患者,共269例;C组为合并房颤未同期处理患者,共98例。观察三组患者术后并发症以及恢复情况。结果C组患者预后较差,机械通气时间更长,肺炎发生率更高,入住重症监护病房(ICU)时间及住院时间均长于其他两组。经过倾向性匹配后,A组与B组在术后神经系统并发症、肾衰竭、肺炎发生率、机械通气时间、死亡率等方面比较,差异均无统计学意义(P>0.05)。结论合并房颤的房间隔缺损患者同期进行迷宫手术并不增加围术期死亡率,迷宫手术后恢复窦性心律比例较高,效果满意,应积极在房间隔缺损矫治手术中同期进行。

Objective To assess the effect of the Cox-maze procedure for adult patients with atrial septal defect （ASD） combined with atrial fibrillation（AF）. Methods A total of 986 patients with ASD above 40 years old were divided into three groups according to presence of AF before opeation. The group A was without AF （sinus rhythm）（n=619）;the group B was com-bined with AF and underwent Cox-maze procedure（n=269）;the group C was combined with AF but without Cox-maze procedure （n=98）. The postoperative complications and recovery conditon of the three groups were observed. Results Compared with the group A and group B,the group C had poorer prognosis,longer duration of mechanical ventilation,higher incidence rate of pneu-monia,longer ICU time and hospital stays. After propensity score matching,there were no statistically significant differences be-tween the group A and group B on postoperative neurological complictions,rennal failure,incidence rate of pneumonia,duration of mechanical ventilation and death rate（P〉0.05）. Conclusion To the patients with ASD and AF,Cox-maze will not increase the death rate during perioperative period ,it has higher proportion of sinus rhythm after operation with satisfactory effect ,so it should be employed in the teatment of ASD actively.