二尖瓣置换术同时行房颤射频消融不增加升主动脉阻断时间的临床研究

Clinical research on radiofrequency ablation for atrial fibrillation without increasing aortic clamping crossing time in mitral valve replacement surgery

目的探讨二尖瓣替换术同时行房颤射频消融不增加阻断心肌循环时间的临床疗效。方法将简阳市人民医院2008年4月至2014年5月115例经心脏超声、x线胸片及心电图检查确诊、心功能Ⅲ级以上（含Ⅲ级）、需二尖瓣置换及房颤改良迷宫双极射频消融的瓣膜性心脏病患者纳入本研究。全组病例分为试验组和对照组，对两组病例的手术安全性、操作难度及手术效果进行统计学分析。结果试验组共72例，男性17例，女性55例，年龄（47．8±6．8）岁；对照组43例，男性8例，女性35例，年龄（49．9±8．4）岁。试验组术后早期急性呼吸功能衰竭2例，经积极治疗均痊愈，全组患者术后无死亡：对照组术后早期发生室性心动过速3例，心室颤动1例，经救治痊愈；2例发生急性呼吸功能衰竭，其中1例最终并发多器官功能不全综合征救治无效死亡。术后即刻、1个月、3个月、6个月、12个月、3年、5年以上窦性心律维持率两组比较未见统计学差异。结论同期房颤射频消融过程中不阻断心肌循环，不影响疗效，不增加手术难度，对重症患者有利，可以扩大同期房颤射频消融手术适应证。

Objective To explore the feasibility of radiofrequency ablation for atrial fibrillation without in- creasing the time to block cardiac cycle in mitral valve replacement surgery. Methods The present study includesthe 115 patients in our hospital between April 2008 and May 2014 who were confirmed to have valvular heart dis- ease, with heart function class llI and above by cardiac ultrasonography, chest X-rays and electrocardiogram, and who needed mitral valve replacement surgery and radiofrequency ablation for atrial fibrillation. Dividing all the cases into experiment group and control group, we use statistical methods to analyze the surgical safety, diffieuhy and ef- fects of the two groups. Results 72 cases were in the experiment group, with the age of （47.8±6.8）years old, a- mong which 17 cases were male and 55 cases female. 43 cases were in the control group, with the age of （49.9±8.4） years old, among which 8 cases were male and 35 cases female. After operation, the experiment group has no case of death, with 2 cases of respiratory failure in the early stage but both cured after active treatment. Early after operation, the control group has 3 cases of ventricular tachycardia and 1 case of ventricular fibrillation but all cured after treatment, and 2 cases of respiratory failure, 1 of which died despite medical treatment because of concurrent multiple organ dysfunction syndrome. The two groups have no significant difference in sinus rhythm maintenance rates after surgery, in 1 month, 3 months, 6 months, 12 months, 3 years and 5 years. The difference in ear- diopulmonary bypass time of the two groups was statistically significant, while the time for atrial fibrillation ablation of the two groups was not. Conclusion In radiofrequeney ablation for atrial fibrillation, non-blockage of cardiac cycle will neither affect the surgical effect nor increase the surgical difficulty, which is beneficial to the patients with severe illness, thus radiofrequency ablation for atrial fibrillation surgery can be expanded.