【摘要】：目的:研究不同雙極射頻消融術(shù)式治療風心病合并房顫的療效及安全性。方法:研究分三部分第一部分回顧分析瓣膜置換同期雙極射頻消融術(shù)治療房顫對心功能恢復影響收集2011年1月至2011年12月新橋醫(yī)院心外科同一手術(shù)組收治的191例瓣膜病合并房顫(AF)患者的臨床資料,研究分為對照組(單純接受瓣膜置換者)和消融組(瓣膜置換同期行雙極射頻消融者),分別統(tǒng)計兩組患者術(shù)前、術(shù)中資料,及出院前,術(shù)后6月,1年,2年心臟超聲,心電圖及相關(guān)并發(fā)癥,并通過來院隨訪、電話、書信問卷等途徑評估心臟功能,采集數(shù)據(jù)并進行統(tǒng)計學分析。第二部分回顧分析不同雙極射頻消融術(shù)治療風心病合并房顫的早期療效收集2012年5月至2012年12月新橋醫(yī)院心外科施行瓣膜置換同期雙極射頻消融手術(shù)197例患者的臨床資料,研究分為雙房消融組行完全雙房雙極消融;簡化右房消融組行左房加簡化右房雙極消融。收集資料指標同前。第三部分前瞻性研究不同消融術(shù)治療風心病合并房顫的安全性及療效采用隨機、開放、平行對照研究,納入2012年3月至2013年2月,新橋醫(yī)院心外科擬接受二尖瓣置換同期雙極射頻消融的患者73例,隨機分為雙房消融組和簡化右房消融組,術(shù)前由第三方告知具體消融術(shù)式。收集術(shù)前、術(shù)中、術(shù)后臨床資料,以及術(shù)后隨訪3、6、12、18、24個月的心臟超聲,心電圖及并發(fā)癥,比較兩種方法的療效。結(jié)果:第一部分兩組均無手術(shù)死亡、心臟破裂、無永久起搏器患者;術(shù)后1年、2年LVFS,EF同期消融組均高于對照組;術(shù)后1年、2年患者自覺心功能改善率同期消融組均高于對照組。第二部分簡化右房消融組與雙房消融組術(shù)前資料比較均無差異;圍手術(shù)期并發(fā)癥無明顯差異;術(shù)后第一天臨時起搏器使用率無明顯差異,隨訪6個月、12個月竇性轉(zhuǎn)復率無明顯差異,6個月、12個月心臟超聲無明顯差異。第三部分術(shù)前比較各組資料均無差異;術(shù)中,術(shù)后簡化右房組主動脈阻斷時間、消融時間、術(shù)中出血量及術(shù)后24 h胸腔引流量明顯少于對照組。隨訪結(jié)果比較兩組患者術(shù)后同期竇性轉(zhuǎn)復率和術(shù)后心功能改善等差異均無統(tǒng)計學意義;結(jié)論:1.瓣膜置換同期雙極射頻消融術(shù)治療房顫手術(shù)安全,竇性轉(zhuǎn)復率明顯高于單純瓣膜置換術(shù),并明顯改善術(shù)后早、中期心功能。2.回顧性及前瞻性研究均顯示,瓣膜置換同期行左房加簡化右房消融與完全雙房消融治療房顫術(shù)后有相似的早期和中期療效;瓣膜置換同期行左房加簡化右房消融手術(shù)較完全雙房消融手術(shù)主動脈阻斷時間、消融時間及術(shù)中和術(shù)后出血量明顯減少。
[Abstract]:Objective: to study the efficacy and safety of different bipolar radiofrequency ablation for rheumatic heart disease complicated with atrial fibrillation. Methods: the first part of the study was divided into three parts: a retrospective analysis of the effects of valvular replacement and bipolar radiofrequency ablation on the recovery of cardiac function in patients with atrial fibrillation. 191 patients treated in the same operation group of Xinqiao Hospital from January 2011 to December 2011 were collected from January 2011 to December 2011. Clinical data of patients with valvular disease complicated with atrial fibrillation (AF), The study was divided into two groups: control group (valve replacement alone) and ablation group (valve replacement patients undergoing bipolar radiofrequency ablation at the same time). The preoperative, intraoperative data and cardiac ultrasound before discharge, 6 months, 1 year and 2 years after operation were counted. Electrocardiogram (ECG) and related complications were evaluated by follow-up, telephone and letter questionnaire, and the data were collected and statistically analyzed. The second part reviews the early efficacy of different bipolar radiofrequency ablation in the treatment of rheumatic heart disease with atrial fibrillation. The clinical data of 197 patients undergoing valve replacement and bipolar radiofrequency ablation in Xinqiao Hospital from May 2012 to December 2012 were collected. The study was divided into two atrium ablation group and complete biatrial bipolar ablation group. The left atrium plus simplified right atrial bipolar ablation was performed in the simplified right atrium ablation group. The data collection index is the same as before. Part III A prospective study on the safety and efficacy of different ablation in the treatment of rheumatic heart disease complicated with atrial fibrillation was included in a randomized, open, parallel controlled study from March 2012 to February 2013, Seventy-three patients undergoing mitral valve replacement and bipolar radiofrequency ablation were randomly divided into two groups: biatrial ablation group and simplified right atrial ablation group. The clinical data were collected before, during and after operation, and the follow-up of 3,6,12,18,24 months after operation were performed to compare the effects of the two methods on echocardiography, ECG and complications. Results: in the first part, there was no operative death, cardiac rupture and no permanent pacemaker in both groups, and the LVFS,EF simultaneous ablation group was higher than the control group at 1 year and 2 years after operation. One year and two years after operation, the improvement rate of conscious cardiac function in the ablation group was higher than that in the control group. In the second part, there was no significant difference in preoperative data between simplified right atrial ablation group and biatrial ablation group, and there was no significant difference in perioperative complications. There was no significant difference in the utilization rate of temporary pacemaker on the first day after operation. There was no significant difference in sinus recovery rate at 6 months and 12 months after follow-up, but there was no significant difference in echocardiography at 6 months and 12 months after operation. In the third part, there was no difference in the data of each group before operation, and the aortic occlusion time, ablation time, intraoperative bleeding volume and thoracic drainage 24 hours after operation in the right atrium group were significantly lower than those in the control group. There was no significant difference in sinus recovery rate and improvement of cardiac function between the two groups in the same period after operation. Conclusion: 1. Valve replacement combined with bipolar radiofrequency ablation is safe in the treatment of atrial fibrillation. The sinus recovery rate is significantly higher than that of valve replacement alone, and the cardiac function in the early and middle stage after operation is significantly improved. 2. Retrospective and prospective studies showed that left atrium plus simplified right atrium ablation was similar to complete biatrial ablation in the treatment of atrial fibrillation. Compared with complete biatrial ablation, the aortic cross-clamping time, ablation time and intraoperative and postoperative bleeding volume were significantly decreased in valve replacement with left atrium plus simplified right atrium ablation.
【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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