切割与射频对风湿性二尖瓣病变合并房颤的疗效

Comparison of the therapeutic effects between simplified left mazeⅢand COX mazeⅣsurgery in treatment of rheumatic mitral valve disease combined with atrial fibrillation

目的比较采用切割的简化左侧mazeⅢ型(SLMⅢ)与射频消融Cox mazeⅣ(CMⅣ)型手术在治疗风湿性二尖瓣病变合并房颤的疗效,以及血清心肌损伤及炎性因子IL-6、cTnI的变化,评估不同能量形式房颤手术的临床实用价值。方法选取2013年1月至2018年7月风湿性二尖瓣合并房颤患者44例,根据二尖瓣术中实施的房颤手术类型分为SLMⅢ型组和CMⅣ型组,对比2组一般临床资料、术中主动脉阻断及体外循环(CPB)时间,术后24 h引流量,呼吸机辅助等指标,监测不同时期2组心律变化及血清白细胞介素6(IL-6)、心肌肌钙蛋白I(cTnI)的变化。结果SLMⅢ型组主动脉阻断及CPB时间较CMⅣ型组明显延长,而术后24 h引流量,呼吸机辅助时间等围朮期指标无明显差异(CP>0.05),术后2组窦性恢复率相当,而SLMⅢ型组血清IL-6、cTnI明显高于CMⅣ型组(P=0.019、0.028)。结论以切割为主的SLMⅢ型手术与射频消融Cox mazeⅣ型手术对房颤治疗的疗效相当,然而SLMⅢ型手术对心肌损伤较重,炎性因子IL-6水平较高。

Objective To compare the therapeutic effects between simplified left mazeⅢ(SLMⅢ)and radiofrequency ablation Cox mazeⅣ(CMⅣ)surgery in treatment of rheumatic mitral valve disease combined with atrial fibrillation,and to observe the changes of serum myocardial damage and inflammatory factor including IL-6,cTnI,so as to evaluate the clinical value of of different surgery methods.Methods Forty-four patients with rheumatic mitral valvular combined with atrial fibrillation were enrolled in the study,who were divided into SLMⅢgroup and CMⅣgroup.The general clinical data,time of intraoperative aortic occlusion and cardiopulmonary bypass(CPB)time,24-hour drainage volume after operation,ventilator-assisted and the other related indexes,and the changes of heart rhythm,IL-6 and cTnI were observed and compared between the two groups.Results The aortic occlusion time and CPB time in SLMⅢgroup were significantly longer than those in CMⅣgroup,however,there were no significant differences in perioperative indexes including drainage volume and ventilator-assisted time at 24 hours after operation as well as sinus recovery rate between the two groups(P>0.05).Moreover the serum levels of IL-6 and cTnI in SLM typeⅢgroup were significantly higher than those in CM typeⅣgroup(P<0.05).Conclusion The therapeutic effects of SLMⅢoperation are similar to those of Cox mazeⅣoperation in treatment of rheumatic mitral valve disease combined with atrial fibrillation.However the SLM typeⅢsurgery may result in severe myocardial damage and higher levels of the inflammatory factor-IL-6.