风湿性心脏病瓣膜置换术后心房颤动复律的临床分析

Clinical analysis of conversion of atrial fibrillation after valve replacement in patients with rheumatic heart valve disease

目的 探讨风湿性心脏病瓣膜置换术后心房颤动转复为窦性心律的情况及影响因素。方法 对 2 0 0 0年 1月至2 0 0 2年 1月 132例风湿性心脏病合并心房颤动行瓣膜置换术患者进行回顾性研究 ,根据患者的病史、手术前后超声心动图、心电图和术后 6个月的随访结果对手术后不同时间心房颤动转复为窦性心律的比例及影响因素进行分析。结果 术后自动复跳或电击复跳转复为窦性心律有 78例 (5 9.0 9% ) ,维持 2 4 h以上有 4 3例 (32 .5 8% ) ,窦性心律维持 2周以上有 2 1例 (15 .91% ) ,6个月以后则有 2 3例 (17.4 2 % )为窦性心律。术后即刻转复为窦性心律与心房颤动持续时间、心胸比例、左心房内径、右心房内径、肺动脉高压、术后电击复跳次数等因素有关 ,窦性心律的维持与心房颤动持续时间、左心房内径、肺动脉高压等有关。结论 瓣膜置换术可使部分风湿性心脏病合并心房颤动患者恢复窦性心律 ,术前心房颤动持续时间、左心房内径。

Objective To evaluate the rate and the effect factors of the restoration of sinus rhythm by valve replacement in patients with rheumatic heart disease (RHD) and atrial fibrillation(AF).Methods From January 2000 to January 2002, 132 consecutive patients with RHD and AF who underwent valve replacement were analysed retrospectively. For this study, clinical histories, laboratory investigations including electrocardiograms, echocardiograms, and the 6 months follow up data were viewed to evaluate the rate and predictors the restoration of sinus rhythm. Results 78 patients (59.09%) regained sinus rhythm after operation, but only 43 patients(32.58%)、21 patients(15.91%),23 patients(17.42%) maintained sinus rhythm more than 24 hours,2 weeks,6 months ,respectively. Duration of AF, left atrial size, right atrial size, cardio thoracic ratio,shock cardioversion and pulmonary hypertension were the significant predictors affecting AF conversion after operation immediately, Duration of AF, left atrial size and pulmonary hypertension were important definitive factors to influence the maintaining of sinus rhythm after operation. Conclusion AF can restore sinus rhythm in some patients with RHD after valve replacement, Duration of AF, left atrial size and pulmonary hypertension were important factors to influence the maintaining of sinus rhythm.