房颤射频消融术对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响

Effects of Radiofrequency Ablation of Atrial Fibrillation on Cardiac Function,Myocardial Injury and Prognosis in Patients with Heart Bypass Combined with Heart Valve Surgery

目的探究房颤射频消融术(RA)对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响。方法选取我院2022年2月至2023年3月接受心脏搭桥合并心脏瓣膜手术患者50例,随机数字表法将其分为观察组25例(房颤RA治疗)与对照组25例(保守药物治疗)。对比两组手术相关指标、不同时间点心肌损伤[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)]及心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]指标,术后随访3个月,统计患者窦性心律转复及心脑血管不良事件(MACCE)发生率。结果观察组体外循环时间比对照组长,总住院时间比对照组短,差异均有统计学意义(P<0.05)。两组术后血清CK-MB、cTnI、NT-proBNP水平均呈现先上升、后下降趋势(P<0.05);观察组术后2 h血清CK-MB、cTnI、NT-proBNP水平均显著高于对照组(P<0.05),但两组间术后48 h上述指标差异均无统计学意义(P>0.05)。术后3个月,观察组比对照组LVEF[(49.78±2.35)%vs.(45.03±2.17)%]显著上升,LVEDD[(54.93±4.30)mm vs.(57.38±4.16)mm]、LVESD[(39.62±4.37)mm vs.(46.15±5.23)mm]显著下降(P<0.05)。观察组术后第1天、出院时及术后3个月窦性心律转复率均显著高于对照组(P<0.05),术后3个月内MACCE两组对比差异无统计学意义(P>0.05)。结论房颤RA能有效改善心脏搭桥合并心脏瓣膜手术患者心功能,提高窦性心律转复率,短期预后好,但可能引发一过性心肌酶上升。

Objective To investigate the effects of radiofrequency ablation of atrial fibrillation(RA)on cardiac function,myocardial injury and prognosis in patients with heart bypass combined with heart valve surgery.Methods From February 2022 to March 2023,50 patients who received heart bypass combined with heart valve surgery in our hospital were selected and divided into observation group(OG,n=25,with atrial fibrillation RA)and control group(CG,n=25,with conservative drug therapy)according to the random number table method.Postoperative indexes,myocardial injury at different time points[creatine kinase isoenzyme(CK-MB),troponin I(cTnI),N-terminal brain natriuretic peptide precursor(NT-proBNP)]and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)]were compared.The incidence of sinus cardioversion and major adverse cardiac and cerebrovascular events(MACCE)were measured after 3 months follow-up.Results The duration of cardiopulmonary bypass in OG was significantly longer than that in CG with statistically significant difference(P<0.05),and the total hospitalization time in OG was significantly shorter than that in CG(P<0.05).Serum CK-MB,cTnI and NT-proBNP in both groups firstly increased and then decreased(P<0.05).Serum CK-MB,cTnI and NT-proBNP in OG were significantly higher than those in CG at 2 h after surgery(P<0.05),but there were no statistically significant differences in the above indexes at 48h after surgery(P>0.05).At 3 months after surgery,LVEF[(49.78±2.35)%vs.(45.03±2.17)%]in OG significantly increased compared with that in CG,while LVEDD[(54.93±4.30)mm vs.(57.38±4.16)mm]and LVESD[(39.62±4.37)mm vs.(46.15±5.23)mm]significantly decreased(P<0.05).The sinus cardioversion rate in OG was significantly higher than that in CG on the 1st day after surgery,at discharge and 3 months after surgery(P<0.05),and there was no statistically significant difference in MACCE within 3 months after surgery(P>0.05).Conclusion Atrial fibrillation RA could effectively improve the cardiac function of patients with heart bypass combined with heart valve surgery,reduce myocardial injury,and increase sinus cardioversion rate,with good short-term prognosis,but may cause transient myocardial enzyme increase.