左房前后径和血浆NT-proBNP在COX-MAZEⅣ手术同期心脏瓣膜手术治疗持续性瓣膜性心房颤动前后的变化研究

Changes of left atrial anteroposterior diameter and N-terminal pro-brain natriuretic peptide before and after COX-MAZEⅣoperation combined with simultaneous cardiac valve surgery for persistent valvular atrial fibrillation

目的探讨治疗持续性瓣膜性心房颤动(房颤)患者采用COX-MAZEⅣ(迷宫Ⅳ)手术同期心脏瓣膜手术的疗效。方法选择于2016年1月至2020年12月于河南省郑州市第七人民医院心脏外科就诊的100例持续性瓣膜性房颤患者,以单纯心脏瓣膜手术治疗的47例为对照组,另以COX-MAZEⅣ手术同期心脏瓣膜手术治疗的53例为观察组,对比两组患者的手术相关指标、疗效、并发症发生等情况。结果观察组患者的主动脉阻断时间、体外循环时间与对照组相比明显升高(P<0.05)。术后6个月观察组的左房前后径、N末端脑钠肽前体(NT-proBNP)显著低于术前,与对照组相比均明显降低(P<0.05);观察组患者术后房颤转复窦性心律、维持窦性心律占比与对照组相比明显升高(P>0.05);两组术后各时间点的肌钙蛋白I(cTnI)水平变化与并发症发生率无显著差异(P>0.05)。结论COX-MAZEⅣ手术同期心脏瓣膜手术治疗可提高患者术后转复窦性心律、维持窦性心律占比率,同时不明显增加并发症发生率与心肌受损程度,具有较好的临床疗效和安全性。

Objective To discuss the curative effect of COX-MAZE IV operation combined with simultaneous cardiac valve surgery in patients with persistent valvular atrial fibrillation(AF).Methods AF patients(n=100)were chosen from Department of Cardiac Surgery in the Seventh People’s Hospital of Zhengzhou City of Henan Province from Jan.2016 to Dec.2020.The patients(n=47)treated with simple cardiac valve surgery were included into control group,and those(n=53)treated with COX-MAZE IV operation combined with simultaneous cardiac valve surgery were included into observation group.The indexes related to the surgery,curative effect and incidence of complications were compared between 2 groups.Results Compared with control group,aortic cross clamp time and cardiopulmonary bypass time increased significantly in observation group(P<0.05).The levels of left atrial anteroposterior diameter(LAAPD)and plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)were significantly lower in observation group after the operation for 6 months than before,and decreased significantly compared with control group(P<0.05).The cardioversion proportion of cases from AF to sinus rhythm and ratio of cases of maintained sinus rhythm increased significantly in observation group after the operation(P>0.05).The level changes of cardiac troponin I(cTnI)at different time points and incidence rate of complications had no significant difference between 2 groups(P>0.05).Conclusion COX-MAZEⅣoperation combined with simultaneous cardiac valve surgery can increase the proportions of cases transferred from atrial fibrillation to sinus rhythm and cases of maintained sinus rhythm,and don’t increase incidence rate of complications and myocardial damage at the same time,which has higher clinical efficacy and safety.