本文選題：心臟瓣膜置換 + 心房纖顫　； 參考：《遵義醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:對(duì)心內(nèi)直視下瓣膜置換同期行雙極射頻消融治療心房纖顫(Atrial fibrillation,AF)的臨床療效進(jìn)行總結(jié),并分析術(shù)前危險(xiǎn)因素與術(shù)后轉(zhuǎn)復(fù)律之間的關(guān)系。方法:回顧性分析2009年11月至2014年4月在貴州省人民醫(yī)院心外科同一手術(shù)治療組行心內(nèi)直視下瓣膜置換同期行雙極AF射頻消融術(shù)病例219例,其中男53例,女166例;年齡20歲~74歲,平均(46.80±10.03)歲;術(shù)前行心電圖及超聲心動(dòng)圖了解心律及心功能指標(biāo)。術(shù)中行射頻消融路線相同,術(shù)后定期復(fù)查心電圖并口服胺碘酮半年,隨訪半年以上,行心電圖出現(xiàn)竇性P波則表明轉(zhuǎn)律成功,根據(jù)心電圖結(jié)果,將患者分為竇性心律(Sinus rhythm,SR)組與非SR組,應(yīng)用統(tǒng)計(jì)學(xué)方法比較兩組患者術(shù)前及術(shù)中相關(guān)因素是否具有統(tǒng)計(jì)學(xué)意義。結(jié)果:患者術(shù)中體外循環(huán)時(shí)間83 min-243 min,平均(124.80±36.04)min;主動(dòng)脈阻斷時(shí)間65 min-204 min,平均(103.86±31.59)min;術(shù)中失血量100 ml-1500ml,平均(710.00±281.79)ml;術(shù)后機(jī)械通氣時(shí)間1.5 h-167h,平均(12.47±17.42)h;術(shù)后住ICU時(shí)間12 h-408 h,平均(28.59±33.79)h;術(shù)后住院時(shí)間6天-41天,平均(14.14±5.05)天;圍手術(shù)期死亡5.48%(12/219),其中,因術(shù)中低心排死亡2例、術(shù)后低心排死亡3例、術(shù)后惡性心律失常死亡3例、術(shù)后多器官功能衰竭死亡3例、術(shù)后心臟后壁出血死亡1例。排除圍手術(shù)期死亡病例,其余207例中,術(shù)后二次開胸止血1.45%(3/207)、急性腎衰1.45%(3/207)、切口愈合不良2.90%(6/207)、臨時(shí)起搏器使用31.88%(67/207)。出院時(shí)SR79.00%(173/219),非SR 15.53%(34/219)。出院后隨訪6~58個(gè)月,平均(27.96±15.57)個(gè)月,隨訪率83.57%(173/207),失訪率16.43%(34/207),隨訪期間死亡1.73%(3/173),維持SR 89.02%(154/173),非SR10.98%(19/173)。安裝永久起搏器0.58%(1/173),因術(shù)后復(fù)發(fā)室上性心動(dòng)過速行導(dǎo)管射頻消融0.58%(1/173)。隨訪期間因不明原因猝死1.73%(3/173),其中猝死病例中有2例術(shù)后一直為AF心律,1例為SR。單因素分析示左房?jī)?nèi)徑(Left atrial diameter,LAD)、年齡及高血壓病是影響術(shù)后轉(zhuǎn)復(fù)的危險(xiǎn)因素(P0.05)。結(jié)論:患者在經(jīng)嚴(yán)格挑選后行心內(nèi)直視下瓣膜置換同期射頻消融治療AF安全、有效,LAD大、年齡大及高血壓病可降低術(shù)后轉(zhuǎn)復(fù)率。
[Abstract]:Objective: to summarize the clinical efficacy of bipolar radiofrequency ablation (RF) in the treatment of atrial fibrillation with open heart valve replacement, and to analyze the relationship between preoperative risk factors and postoperative cardioversion. Methods: from November 2009 to April 2014, 219 patients (53 males and 166 females) with bipolar AF radiofrequency ablation were retrospectively analyzed in the same surgical group of cardiac surgery in Guizhou Provincial people's Hospital. The average age was 46.80 鹵10.03 years. Electrocardiogram (ECG) and echocardiography were performed before operation to understand cardiac rhythm and cardiac function. The same route of radiofrequency ablation was performed during the operation. Electrocardiogram (ECG) was reviewed regularly and amiodarone was taken orally for half a year, followed up for more than half a year. The occurrence of sinus P wave in electrocardiogram showed that the conversion was successful. The patients were divided into two groups: sinus rhythmosis group and non-SR group. The statistical method was used to compare the correlation factors before and during operation between the two groups. Results: the operative time of cardiopulmonary bypass (CPB) was 83 min-243 (mean 124.80 鹵36.04 min), aortic occlusion time was 65 min-204 (mean 103.86 鹵31.59 min), blood loss during operation was 100ml-1500 ml (mean 710.00 鹵281.79 ml), postoperative mechanical ventilation time was 1.5h-167 h (mean 12.47 鹵17.42 h), postoperative ICU time was 12 h ~ 408 h (mean 28.59 鹵33.79 h). Hospital time 6 days to 41 days, The average death was 14.14 鹵5.05 days, and the perioperative death was 5.48% / 219g, in which 2 cases died of low cardiac output, 3 cases died of postoperative low cardiac output, 3 cases died of malignant arrhythmia, 3 cases died of multiple organ failure, and 1 case died of posterior cardiac hemorrhage. Of the 207 patients who died during the perioperative period, the other 207 cases were treated with second thoracotomy and hemostasis (1.45 / 207), acute renal failure (1.45 / 207), bad wound healing (2.90% / 207), temporary pacemaker with 31.88% 67 / 207. At discharge, SR79.00 had 173 / 219s, and non-SR 15.53s 34 / 219g. The follow-up rate was 83.57% (173 / 207m), and the missing rate was 16.43 / 207m. During the follow-up period, the death rate was 1.73 / 173C, maintaining SR 89.02 / 1734 / 173C, not SR10.98 / 173C / 1730.The average follow-up rate was 27.96 鹵15.57 months after discharge, and the average follow-up rate was 27.96 鹵15.57 months, and the follow-up rate was 16.43 / 207.The death rate during the follow-up period was 1.73 / 173, and maintained SR 89.02 / 173C, not SR10.98 / 173N. Installation of permanent pacemaker 0.58 / 173a, because of recurrent supraventricular tachycardia, radiofrequency catheter ablation of 0.58 / 173. During the follow-up period, 1. 73% of sudden death was due to unknown causes. Among them, 2 cases of sudden death were AF arrhythmia and 1 case was SRS. Univariate analysis showed that left atrial diameter (Left atrial diameterladus), age and hypertension were the risk factors for postoperative recovery (P 0.05). Conclusion: it is safe and effective for patients with AF to undergo open heart valve replacement and radiofrequency ablation after strict selection, and to reduce the rate of postoperative recovery with older age and hypertension.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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