COX-MAZE Ⅳ手术同期心脏瓣膜手术心脏左房前后径和NT-proBNP的变化

Changes of left atrial diameter and NT-proBNP in patients with COX-MAZE Ⅳ procedure concomitant valvular surgery

摘要:

目的：研究左房前后径和血浆氨基末端脑利钠肽（NT-probriain natriuretic peptide，NT-proBNP）浓度在COX-MAZE Ⅳ手术同期心脏瓣膜手术治疗持续性瓣膜性房颤患者术前术后的变化。方法：持续不间断地纳入32例持续性瓣膜性房颤的患者（房颤组）行COX-MAZE Ⅳ手术同期心脏瓣膜手术，同期窦性心律患者单纯性心脏瓣膜手术（窦性心律）18例为对照组。房颤组再根据术后心律，分为房颤-窦性组19例，房颤-房颤组13例。术前、术后6个月分别行心电图，24 h心电图，检测心律状态，行心脏超声，测量左房前后径和左室射血分数（left ventricular ejection fraction，LVEF），检测血浆NT-proBNP浓度。结果：房颤组和窦性组比较，术前左房前后径有统计学差异[（53.53±9.48） mm vs.（41.11±6.31） mm，P=0.000]，LVEF无统计学差异[（52.53±7.03）% vs.（58.00±5.87）%，P=0.07）]，血浆NT-proBNP浓度有统计学差异[（2 792±1 582） pg/mL vs.（1 035±833） pg/mL，P=0.000]。房颤-窦性组和房颤-房颤组比较，术前左房前后径有统计学差异[（49.90±1.70） mm vs.（58.85±9.92） mm，P=0.007]，术前LVEF无统计学差异[（53.37±1.49）% vs.（51.31±7.83）%，P=0.424]，术前血浆NT-proBNP有统计学差异[（2 298±261） pg/mL vs. （3 514±1 892） pg/mL，P=0.03]。术后6个月左房前后径有统计学差异[（41.84±1.12） mm vs.（48.23±8.12） mm，P=0.009]，术后6个月LVEF有统计学差异[（58.58±0.62）% vs. （54.08±5.47）%，P=0.04]，术后6个月血浆NT-proBNP有统计学差异[（489±84） pg/mL vs.（1 408±1 176） pg/mL，P=0.017]。结论：左房前后径增大，血浆NT-proBNP浓度升高是瓣膜疾病并发房颤的危险因子。年龄、左房前后径增大、血浆NT-proBNP升高是瓣膜手术同期COX-MAZE Ⅳ手术术后房颤的复发高危因子。而术后6个月的左房前后径、左室射血分数、血浆NT-proBNP浓度与术后窦性心律的维持有关。

Abstract:

Objective：To access the changes of left atrial diameter and NT-proBNP in patients with COX-MAZE Ⅳ procedure con－comitant valvular surgery. Methods：A total of 50 patients were consecutively recruited and divided into 3 groups：sinus group，AF-sinus group，AF-AF group. Left ventricular ejection fraction（LVEF） and left atrial diameter were measured by echocardiography before and 6 months after procedure. Plasma NT-proBNP levels were measured before and 6 months after procedure. Results：The left atrial di－ameters before procedure were significantly different between sinus group and AF group [（53.53±9.48） mm vs. （41.11±6.31） mm，P=0.000]. The plasma NT-proBNP levels were also significantly different [（2 792±1 582） pg/mL vs. （1 035±833） pg/mL，P=0.000]. But the LVEF values were not [（52.53±7.03）% vs. （58.00±5.87）%，P=0.07]. The left atrial diameters before procedure were different between AF-sinus group and AF-AF Group [（49.90±1.70） mm vs. （58.85±9.92） mm，P=0.007] and the plasma NT-proBNP levels were also differene [（2 298±261） pg/mL vs. （3 514±1 892） pg/mL，P=0.03]. The LVEF values were not [（53.37±1.49） % vs. （51.31±7.83）%，P=0.424]. The left atrial diameters after 6 months procedure were different between AF-sinus group and AF-AF group[（41.84±1.12） mm vs. （48.23±8.12） mm，P=0.009] and the plasma NT-proBNP levels were different [（489±84） pg/mL vs. （1 408±1 176） pg/mL，P=0.017]. The LVEF values were also different [（5408±5.47）% vs. （58.58±0.62）%，P=0.04]. Conclusion：The left atrial diameters and the plasma NT-proBNP levels are the risk factors of occurrence of AF in patients with valvular diseases. The more left atrial diameters and the plasma NT-proBNP levels before procedure tend to AF recurrence and the less left atrial diameters and the plasma NT-proBNP levels，the more LVEF values are beneficial to sinus rhythm restoration.