冠状动脉粥样硬化性心脏病合并二尖瓣疾病和心房颤动患者同期行冠状动脉搭桥联合二尖瓣置换术和双极射频消融术疗效观察

Clinical effect of coronary artery bypass grafting and mitral valve replacement and bipolar radiofrequency ablation on the patients with coronary atherosclerotic heart disease combined with mitral valve disease and atrial fibrillation

目的探讨冠状动脉粥样硬化性心脏病合并二尖瓣疾病和心房颤动患者同期行冠状动脉搭桥联合二尖瓣置换术和双极射频消融术的临床效果。方法将2015年11月至2017年11月河南大学淮河医院收治的132例冠状动脉粥样硬化性心脏病合并二尖瓣疾病和心房颤动患者分为对照组和观察组,每组66例。对照组患者给予冠状动脉搭桥和二尖瓣机械瓣膜置换手术;观察组患者给予冠状动脉搭桥和二尖瓣机械瓣膜置换术,并同期行双极射频消融术。观察2组患者呼吸机辅助呼吸时间、体外循环时间、术中出血量、主动脉阻断时间、术后24 h胸腔积液量、重症监护室(ICU)入住时间、术后住院时间,比较术前和术后6个月左心房内径、左心室短轴缩短率、左心室射血分数及出院时和术后6个月窦性心律转复情况。结果观察组患者体外循环时间及主动脉阻断时间显著长于对照组(P <0. 01)。2组患者呼吸机辅助呼吸时间、术中出血量、术后24 h胸腔积液量、ICU入住时间及术后住院时间比较差异无统计学意义(P> 0. 05)。2组患者术前左心房内径、左心室短轴缩短率、左心室射血分数比较差异无统计学意义(P>0. 05)。2组患者术后6个月左心房内径显著小于术前,左心室短轴缩短率及左心室射血分数显著高于术前(P <0. 05)。观察组患者术后6个月的左心房内径显著小于对照组,左心室短轴缩短率及左心室射血分数显著高于对照组,差异均有统计学意义(P <0. 05)。对照组患者出院时和术后6个月窦性心律转复率分别为45. 5%(30/66)和22. 7%(15/66),观察组患者出院时和术后6个月窦性心律转复率分别为69. 7%(46/66)和80. 3%(53/66);观察组患者出院时及术后6个月窦性心律转复率显著高于对照组(χ~2=7. 940、43. 801,P <0. 01)。结论冠状动脉搭桥联合二尖瓣置换术和双极射频消融术是一种安全有效的手术方式,能显著改善患者的心功能状况,并提高术后窦性心律转复率。

Objective To investigate the clinical effect of coronary artery bypass grafting and mitral valve replacement and bipolar radiofrequency ablation on the patients with coronary atherosclerotic heart disease combined with mitral valve disease and atrial fibrillation.Methods A total of one hundred and thirty-two patients with coronary atherosclerotic heart disease combined with mitral valve disease and atrial fibrillation in Huaihe Hospital of Henan University from November 2015 to November 2017 were divided into control group and observation group,with 66 cases in each group.In the control group,the patients were given coronary artery bypass grafting and mitral valve mechanical replacement.The patients in the observation group received coronary artery bypass grafting and mitral valve mechanical replacement,and underwent bipolar radiofrequency ablation at the same time.The ventilator assisted breathing time,extracorporeal circulation time,intraoperative blood loss,aorta blocking time,chest fluid volume at 24 hours after operation,intensive care unit(ICU)admission time,postoperative hospitalization time,left atrium diameter and minor axis shortening rate of left ventricle and left ventricular ejection fraction before operation and at six months after operation,sinus rhythm converting at out of hospital and six months after operation in the two groups were observed.Results The extracorporeal circulation time and aorta blocking time in the observation group were significantly longer than those in the control group(P<0.01).There was no statistically significant difference in ventilator assisted breathing time,intraoperative blood loss,chest fluid volume at 24 hours after operation,ICU admission time and postoperative hospitalization time between the two groups(P>0.05).There was no significant difference in the left atrium diameter,left ventricular short axis reduced rate and left ventricular ejection fraction between the two groups before operation(P>0.05).At six months after operation,the left atrium diameter was smaller than that before surgery,minor axis shortening rate of left ventricle and left ventricular ejection fraction were higher than those before surgery in the observation group(P<0.05).Compared with the control group,the left atrium diameter was smaller,minor axis shortening rate of left ventricle and left ventricular ejection fraction were higher than those at six months after operation in the observation group(P<0.05).The rate of sinus rhythm conversion was 45.5%(30/66)and 22.7%(15/66)in the control group at discharge and six months after surgery,respectively.The rate of sinus rhythm conversion was 69.7%(46/66)and 80.3%(53/66)in the observation group at discharge and six months after surgery,respectively.The rate of sinus cardioversion was significantly higher in the observation group than that in the control group at discharge and six months after surgery(χ^2=7.940,43.801;P<0.01).Conclusion Bipolar radiofrequency ablation in patients undergoing coronary artery bypass grafting and mitral valve replacement is safe and effective.It can significantly improve the patient′s heart function and improve the rate of sinus rhythm after operation.