射频消融联合左心耳闭合术治疗瓣膜病房颤疗效观察

Radiofrequency ablation combined with left atrial appendage closure in the treatment of valvular disease complicated with atrial fibrillation

摘要:

目的： 研究射频消融联合左心耳闭合术治疗瓣膜病房颤的手术疗效。方法： 收集瓣膜病合并房颤患者120例，观察组56例（射频消融联合左心耳闭合+瓣置换术），对照组64例（瓣置换术）。观察2组手术指标、窦性转复率、心功能指标、血液中相关因子及并发症。结果： 观察组手术和体外循环时间长于对照组（t=3.129，P=0.002；t=5.873，P=0.000），其他指标无统计学差异；观察组手术结束时、术后3 d、出院前、术后3个月、术后6个月及术后1年转复率分别是83.3%、57.4%、59.3%、72.2%、74.1%及75.9%，对照组为14.5%、11.3%、11.3%、8.1%、9.7%及8.1%，2组比较均具有统计学差异（P=0.000）；观察组心功能指标和血液中相关因子变化均优于对照组。随访统计，观察组患者并发症（脑梗死和出血）发生率较低（χ²=4.551，P=0.033；χ²=5.716，P=0.017）。结论： 射频消融联合左心耳闭合术是安全可靠的，在预防血栓栓塞中具有特殊意义。

Abstract:

Objective: To study the surgical effect of radiofrequency ablation combined with left atrial appendage closure in treating valvular disease complicated with atrial fibrillation. Methods: A total of 120 patients with cardiac mitral valve disease and atrial fibrillation in our hospital were collected and divided into the study group-patients after mitral valve surgery with concomitant radiofrequency surgical ablation and left atrial appendage closure (56 cases), and the control group-patients undergoing only mitral valve surgery (64 cases) according to the type of operation. Operation indicators, sinus rhythm restoration rates, cardiac function, correlation factors in blood and complications were observed. Results: The operation time and cardiopulmonary bypass time in the study group were longer than those in the control group (t=3.129, P=0.002; t=5.873, P=0.000), and other indexes were not different. The sinus rhythm restoration rate in the study group was 83.3%at the end of the operation, 57.4%at the 3rd day after operation, 59.3%before discharging hospital, 72.2%at the 3rd month after operation, 74.1%at 6th months after operation and 75.9%at one year after operation; the sinus rhythm restoration in the control group were 14.5%at the end of the operation, 11.3%at the 3rd day after operation, 11.3%before discharging hospital, 8.1%at the 3rd month after operation, 9.7%at the 6th month after operation and 8.1%at one year after operation, with statistically significant differences (P=0.000). The cardiac function and factors in blood in the study group were better than those in the control group. According to follow-up, the incidence of complications (cerebral infarction and hemorrhage) in the study group was lower than that of the control group (χ²=4.551, P=0.033; χ²=5.716, P=0.017). Conclusion: Radiofrequency ablation combined with left atrial appendage closure in treating valvular disease complicated with atrial fibrillation is safe, with significance in preventing thromboembolism.