瓣膜手术同期射频消融治疗心房颤动50例效果观察

Clinical observation of 50 patients with atrial fibrillation treated by valvular surgery and surgical radiofrequency ablation

目的探讨合并心房颤动的心脏瓣膜病病人在行瓣膜置换手术的同期实施射频消融治疗心房颤动的早期临床效果。方法回顾性分析2017年6月至2018年3月,安徽医科大学第一附属医院收治的100例心脏瓣膜病合并心房颤动的病人的临床资料,根据其手术方式进行分组,单纯实施瓣膜置换术的50例病人为对照组,在瓣膜置换术的基础上同期实施射频消融术的50例病人为观察组。对比两组手术病人的术中和术后临床指标,术后生存质量评分、超声心动图参数及心功能(NYHA)分级情况。结果术中体外循环时间、主动脉阻断时间,术后机械通气时间、24 h引流量及住院时间,两组间差异无统计学意义。观察组术后静息[(86.29±16.14)次/分比(96.84±13.45)次/分,P=0.013]及运动时[(105.94±9.28)次/分比(117.81±11.63)次/分,P<0.001]心率均明显低于对照组,且术后生存质量评分:躯体功能[(88.56±8.47)分比(81.28±7.84)分,P<0.001],心理健康[(85.48±8.36)分比(75.93±7.57)分,P<0.001],社会关系[(87.93±9.16)分比(79.16±8.49)分,P<0.001],生活环境[(84.93±8.89)分比(75.83±7.37)分,P<0.001]及窦性心律维持率:术后即刻(88%比12%,P<0.001),出院时(90%比6%,P<0.001),术后1个月(90%比2%,P<0.001),术后6个月(94%比0%,P<0.001)均高于对照组。在术后超声心动图参数及NYHA分级方面上,与术前相比,两组病人的左房内径(LA)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)及NYHA分级均较术前改善,但观察组中LA[(46.7±3.0)mm比(49.1±2.7)mm,P=0.01]、LVEDD[(47.3±4.2)mm比(50.3±4.2)mm,P<0.01]、LVEF[(59.8±3.7)%比(57.1±3.9)%,P=0.01]这些指标在术后6个月时开始优于对照组,此时观察组中NYHA≥Ⅱ级的病人比例也要高于对照组(86%比68%,P=0.032)。结论对心脏瓣膜病合并心房颤动病人实施瓣膜置换术联合同期射频消融术,可有效促使病人窦性心律恢复,改善其心功能,有利于提高其临床疗效,改善其生存质量。

Objective To investigate the early effect of synchronous radiofrequency ablation combined with valve replacement for patients suffering valvular heart disease complicated with atrial fibrillation.Methods The clinical data of 100 patients suffering valvular heart disease complicated with atrial fibrillation in the First Affiliated Hospital of Anhui Medical University from June 2017 to March 2018 was retrospectively analyzed.According to the surgical methods,50 patients who underwent valve replacement alone were selected as the control group and the other 50 patients who underwent synchronous radiofrequency ablation combined with valve replacement were selected as the observation group.The intraoperative and postoperative clinical indexes,postoperative life quality scores,echocardiographic parameters and cardiac function(NYHA)classification were compared between the two groups.Results Intraoperative cardiopulmonary bypass time,aortic cross-clamp time,postoperative mechanical ventilation time,24h drainage volume and hospitalization time were not significant compared with the control group.Heart rate at rest[(86.29±16.14)vs.(96.84±13.45),P=0.013]and exercise[(105.94±9.28)vs.(117.81±11.63),P<0.001]in the observation group were significantly lower.The life quality scores[somatic function[(88.56±8.47)points vs.(81.28±7.84)points,P<0.001],mental health[(85.48±8.36)points vs.(75.93±7.57)points,P<0.001],social relations[(87.93±9.16)points vs.(79.16±8.49)points,P<0.001]social relationship[(87.93±9.16)points vs.(79.16±8.49)points,P<0.001],living environment[(84.93±8.89)points vs.(75.83±7.37)points,P<0.001]and sinus rhythm maintenance rate[immediately after surgery(88%vs.12%,P<0.001),at discharge(90%vs.6%,P<0.001),1 month after surgery(90%vs.2%,P<0.001),and 6 months after surgery(94%vs.0%,P<0.001)in the observation group were higher significantly than those in the control group.In terms of postoperative echocardiographic parameters and NYHA classification,the left atrial diameter(LA),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and NYHA classification in both groups improved compared with before surgery.Forthermore,LA[(46.7±3.0)mm vs.(49.1±2.7)mm,P=0.01],LVEDD[(47.3±4.2)mm vs.(50.3±4.2)mm,P<0.01],LVEF[(59.8±3.7)%vs.(57.1±3.9)%,P=0.01]in the observation group were better than those in the control group at 6 months after surgery.Meanwhile,the proportion of NYHA≥Ⅱpatients in the observation group was also higher than that in the control group(86%vs.68%,P=0.032).Conclusion The implementation of valve replacement combined with synchronous radiofrequency ablation for patients with valvular heart disease and atrial fibrillation can effectively promote the recovery of sinus rhythm and improving cardiac function,improve their clinical efficacy and life quality.