瓣膜置换同期房颤射频消融术后心律失常的防治

Prevention and treatment of arrhythmia in patients after valves replancement and radiofrequency ablation of atrial fibrillation

目的总结瓣膜置换同期行房颤射频消融术后心律失常的防治。方法 2009年6月~2013年6月我院共施行537例瓣膜置换同期房颤射频消融患者,其中479例术后出现心律失常,共发生心律失常1192例次,术后恢复窦性心律的患者给予胺碘酮维持心律,出现心律失常的患者及时给予相应抗心律失常药物治疗,正确应用血管活性药物,维护内环境稳定,严密监测心率、心律变化。结果本组477例患者治愈,2例死亡,1例死于术后严重低心排综合征,1例死于急性呼吸窘迫综合征。结论瓣膜置换同期房颤射频消融术的患者,术后极易发生心律失常,严密监护,维持内环境稳定,积极防治心律失常,对于术后的顺利康复尤其重要。

Objective To summarize the prevention and treatment of arrhythmia in patients after valves replancement and radiofrequency ablation of atrial fibrillation. Methods There were 537 patients who received the surgery of valves replacement and radiofrequency ablation of atrial fibrillation in our hospital from June 2009 to June 2013, 479 cases among them suffered from arrhythmia after surgery, and the total person-time of arrhythmia was 1192. After surgery, patients who restored sinus rhythm were treated with amiodarone to maintain the rhythm, and the patients who suffered arrhythmia were treated with certain antiarrhythmic drugs and vasoactive drugs timely and correctly. The internal homeostasis of patients were maintained, and the heart rates and rhythm changes were strictly monitored. Results 477 patients were cured, while 2 patients died, one patient died of severe low cardiac output syndrome（LCOS）, and the other patient died of acute respiratory distress syndrome（ARDS）. Conclusion Arrhythmia occurs easily in the patients after the surgery of valves replancement and radiofrequency ablation of atrial fibrillation. Careful monitoring, internal homeostasis maintaining, and positively arrhythmia controlling are very important to the smoothly recovery of patients.