双极射频消融术联合人工瓣膜置换术治疗重症心脏瓣膜病合并房颤患者的效果

Effects of bipolar radiofrequency ablation combined with artificial valve replacement in treatment of patients with severe valvular heart disease complicated with atrial fibrillation

目的:观察双极射频消融术联合人工瓣膜置换术治疗重症心脏瓣膜病合并房颤患者的效果。方法:选取2019年3月至2021年3月该院收治的98例重症心脏瓣膜病合并房颤患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各49例。对照组采用人工瓣膜置换术治疗,观察组在对照组基础上联合双极射频消融术治疗,比较两组手术相关指标(手术时间、术中出血量)水平、入住ICU时间、住院时间、心功能指标[左心房内径(LAD)、右心房内径(RAD)、左心室射血分数(LVEF)、左心室缩短分数(LVFS)]水平和并发症发生率。结果:观察组手术时间长于对照组,入住ICU时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后3、6个月,观察组LAD、RAD水平低于对照组,LVEF、LVFS水平高于对照组,差异有统计学意义(P<0.05);两组术中出血量和并发症发生率比较,差异无统计学意义(P>0.05)。结论:双极射频消融术联合人工瓣膜置换术治疗重症心脏瓣膜病合并房颤患者可缩短入住ICU时间和住院时间,改善心功能指标水平,效果优于单纯人工瓣膜置换术治疗,但会延长手术时间。

Objective: To observe effects of bipolar radiofrequency ablation combined with artificial valve replacement in treatment of patients with severe valvular heart disease complicated with atrial fibrillation. Methods: A prospective study was conducted on 98 patients with severe valvular heart disease complicated with atrial fibrillation admitted to the hospital from March 2019 to March 2021. They were divided into observation group and control group according to the random number table method, 49 cases in each. The control group was treated with artificial valve replacement, while the observation group was treated with bipolar radiofrequency ablation on the basis of that of the control group. The operation related index levels(operation time, intraoperative blood loss), the ICU time, the hospitalization time, the cardiac function index levels [left atrial diameter(LAD), right atrial diameter(RAD), left ventricular ejection fraction(LVEF), left ventricular shortening fraction(LVFS)], and the incidence of complications were compared between the two groups. Results: The operation time of the observation group was longer than that of the control group, the ICU time and the hospitalization time were shorter than those of the control group, and the differences were statistically significant(P<0.05). At 3 and 6 months after the surgery, the levels of LAD and RAD in the observation group were lower than those in the control group, the levels of LVEF and LVFS were higher than those in the control group, and the differences were statistically significant(P<0.05). However, there were no significant differences in the intraoperative blood loss and the incidence of complications between the two groups(P>0.05). Conclusions: Bipolar radiofrequency ablation combined with artificial valve replacement in the treatment of the patients with severe valvular heart disease complicated with atrial fibrillation can shorten the ICU time and the hospitalization time, and improve the levels of cardiac function indexes. Moreover, it is superior to single artificial valve replacement, but it will prolong the operation time.