瓣膜手术同期射频消融对心房颤动患者心脏节律的影响

Influence of valve surgery combined with simultaneous radiofrequency ablation on cardiac rhythm in patients with atrial fibrillation

目的分析瓣膜手术同期射频消融治疗心房颤动的临床效果以及对患者心脏节律的影响。方法选取2018年2月至2021年6月湖南师范大学附属第一医院收治的60例合并心房颤动患者作为研究对象,采用随机数字表法分为观察组和对照组,各30例。观察组采用瓣膜手术同期行改良迷宫双极射频消融术进行治疗,对照组采用瓣膜置换及左心耳结扎。比较两组患者的体外循环时间二尖瓣置换(MVR)时间、双瓣置换(DVR)时间、呼吸机使用时间、住院时间、生活质量、并发症发生率以及治疗后的心脏节律变化情况。结果两组患者的呼吸机使用时间、住院时间比较,差异无统计学意义(P>0.05);观察组的体外循环时间MVR、DVR长于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的生活质量评分中的生理功能、健康自评、躯体疼痛、生活活力、生理职能、社会功能、情感角色、心理健康评分及总分比较,差异无统计学意义(P>0.05);观察组治疗后的生活质量评分中的生理功能、健康自评、生活活力、生理职能、社会功能、情感角色、心理健康评分及总分高于对照组,差异有统计学意义(P<0.05);观察组治疗后的生活质量评分中的生理功能、健康自评、生活活力、生理职能、社会功能、情感角色、心理健康评分及总分均高于本组治疗前,差异有统计学意义(P<0.05);对照组治疗后除躯体疼痛外,其他各个维度评分及总分均高于本组治疗前,差异有统计学意义(P<0.05)。术后观察组27例窦性心律,2例心房颤动,1例房扑;对照组13例窦性心律,15例心房颤动,2例房扑。两组患者的术后心脏节律变化情况比较,差异有统计学意义(χ^(2)=15.175,P=0.001)。结论射频消融术是治疗心房颤动的重要术式之一,瓣膜手术同期行改良射频消融是安全的、有效的,有利于进一步提高手术效果,术后能够有效缓解患者的心房颤动症状,且并发症发生率相对较低、程度较轻,可作为瓣膜病合并心房颤动的首选方案。

Objective To analyze the clinical effect of valve surgery combined with simultaneous radiofrequency ablation in the treatment of atrial fibrillation and its effect on patients with cardiac rhythm.Methods A total of 60 patients with atrial fibrillation in the First Affiliated Hospital of Hu′nan Normal University from February 2018 to June 2021 were selected as research subjects,and they were divided into the observation group and the control group by random number table method,with 30 patients in each group.The observation group was treated with valve surgery and modified labyrinth bipolar radiofrequency ablation at the same time,while the control group was treated with valve replacement and left atrial appendage ligation.The cardiopulmonary bypass time,mitral valve replacement(MVR)time,double valve replacement(DVR)time,ventilator use time,hospital stay,quality of life,the incidence of complications and changes of cardiac rhythm after treatment were compared between the two groups.Results There were no significant differences in the ventilator use time and hospital stay between the two groups(P>0.05).The MVR and DVR of the observation group were longer than those of the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the quality of life scores of physiological function,health self-assessment,physical pain,life vitality,physiological function,social function,emotional role,mental health score and total score between the two groups before treatment(P>0.05).The scores of physiological function,health self-assessment,life vitality,physiological function,social function,emotional role,mental health and total scores in the quality of life scores in the observation group after treatment were higher than those in the control group,and the differences were statistically significant(P<0.05).The scores of physiological function,health self-assessment,life vitality,physiological function,social function,emotional role,mental health and total score in the quality of life scores of the observation group after treatment were higher than those before treatment,and the differences were statistically significant(P<0.05).Except for physical pain,the scores of other dimensions and total scores in the control group after treatment were higher than those before treatment,and the differences were statistically significant(P<0.05).There were 27 cases of sinus rhythm,2 cases of atrial fibrillation and 1 case of atrial flutter in the observation group.In the control group,there were 13 cases of sinus rhythm,15 cases of atrial fibrillation and 2 cases of atrial flutter.There was significant difference in the changes of postoperative cardiac rhythm between the two groups(χ^(2)=15.175,P=0.001).Conclusion Radiofrequency ablation is one of the important surgical methods in the treatment of atrial fibrillation.Valve surgery combined with simultaneous modified radiofrequency ablation is safe and effective,which is conducive to further improve the surgical effect.It can effectively alleviate the symptoms of atrial fibrillation after operation,and the incidence of complications is relatively low and mild.It can be used as the first choice for valve disease complicated with atrial fibrillation.