经心外膜左心耳闭合术对高危心脏瓣膜病合并房颤患者早期预后的影响

Effect of Epicardial Left Atrial Appendage Closure on the Early Prognosis of Patients with High-risk Heart Valve Disease Complicated with Atrial Fibrillation

目的探讨瓣膜置换联合心外膜左心耳闭合技术的应用和其对高危心脏瓣膜病合并心房颤动患者的术后及早期预后的影响。方法选取114例行心内直视下心脏瓣膜置换手术的患者作为研究对象,所有患者HASBLED评分≥3分、CHA2DS2-VASc评分≥2(女性≥3),根据是否行左心耳闭合术分为A组(闭合组,58例)和B组(未闭合组,56例),观察2组患者的手术指标、心功能指标、血液中相关因子、术后6个月后心血管不良反应事件发生率。结果与B组相比,A组患者术后血液中C-反应蛋白水平、脑钠肽水平、IL-1β、IL-6及TNF-α水平明显降低(P<0.05);左房内径和左室舒末内径均降低(P<0.05),射血分数升高(P<0.05)。B组患者术后6个月心血管不良反应事件发生的比例高于A组,差异具有统计学意义(P<0.05)。结论经心外膜左心耳闭合术是安全可靠的,术后具有良好的早期疗效,有利于预防术后脑卒中的发生。

Objective To evaluate the impact of valve replacement combined with epicardial left atrial appendage closure with high-risk heart valve disease complicated with atrial fi brillation on short-term outcome.Methods A total of 114 patients who underwent open-heart valve replacement surgery were selected as the research objects.All patients had HAS-BlED score≥3 and CHA2DS2-VASC score≥2(female≥3).According to whether left atrial appendage was closed,patients were divided into group A(closed group,n=58)and group B(unclosed group,n=56).The operation indexes,cardiac function indexes,blood related factors and the incidence of cardiovascular adverse events after 6 months were observed in the two groups.Results The levels of C-reactive protein levels,brain natriuretic peptide,interleukin-1β,interleukin-6 and tumor necrosis factor-αof group A were lower than those of group B(P<0.05).The left atrial diameter and left ventricular enddiastolic diameter of the patients in combined surgery group were decreased(P<0.05),the ejection fraction was increased(P<0.05).The rates of incidence of cardiovascular adverse events occurrence to group B observed six months after operation were higher than those of group A(P<0.05).Conclusion Transepicardial left atrial appendage closure is safe and reliable,and has a good early postoperative effect after operation,which is conducive to the prevention of postoperative stroke.