摘要
目的探讨心脏瓣膜置换联合冠状动脉搭桥患者同期行心房纤颤(房颤)射频消融术的临床应用及效果。方法回顾性分析2016年2月至2018年1月52例心脏瓣膜病合并冠心病及房颤患者的临床资料,根据治疗方案不同,行心脏瓣膜置换联合冠状动脉搭桥及房颤射频消融术的24例为观察组,行心脏瓣膜置换联合冠状动脉搭桥术的28例为对照组;术后随访6个月,对比两组手术指标、血清指标、心脏超声心动图及心电图指标。结果观察组体外循环时间[(885±64)min]、辅助呼吸时间[(6.5±1.3)min]明显长于对照组[(61.2±7.3)min、(4.2±0.8)min,P<0.01,P<0.05];观察组ICU入住时间[(2.1±0.5)d]、住院时间[(15.1±1.7)d]与对照组[(1.8±0.4)d、(14.9±2.2)d]相比无统计学差异(P均>0.05)。观察组术后6个月,血清白细胞介素(IL)-6[(16.3±13.4)mg/L]和几丁质酶-3样蛋白-1(YKL-40)[(2.7±0.5)μg/L]明显低于对照组[(1.9±1.2)mg/L,(3.0±0.6)μg/L,P<0.05]。术后6个月,观察组左心房内径[(40.7±3.4)mm]、左心室舒张末容积[(51.8±6.6)ml]和射血分数[(64.5±6.7)%]与对照组差异均有统计学意义[(51.8±5.6)mm,(60.6±9.4)ml,(60.3±6.5)%,P<0.05,P<0.01]。观察组术后及术后6个月房颤转复窦性心律几率(70.8%,87.5%)明显高于对照组(35.7%,21.4%,P<0.05,P<0.01)。结论心脏瓣膜病合并冠心病及房颤患者同时行心脏瓣膜置换联合冠状动脉搭桥及房颤射频消融术,能够改善患者心功能,降低其血清IL-6及YKL-40水平,提高其房颤转复窦性心律几率。
Objective To investigate the effect of simultaneous radiofrequency ablation of atrial fibrillation in patients with valvular heart disease and atrial fibrillation undergoing coronary artery bypass grafting combined with cardiac valve replacement. Methods The clinical data of 52 patients with valvular heart disease complicated with coronary heart disease and atrial fibrillation from February 2016 to January 2018 were retrospectively analyzed. According to different treatment ,24 patients underwent cardiac valve replacement combined with coronary artery bypass grafting and simultaneous radiofrequency ablation of atrial fibrillation were selected as observation group, and 28 patients underwent cardiac valve replacement combined with coronary artery bypass grafting were selected as control group. The patients were followed up for 6 months, and the operative parameters, serum parameters, cardiac echocardiography and electrocardiogram were compared between the two groups. Results The cardiopulmonary bypass time and assisted breathing time in the observation group were significantly longer than those in the control group [(88.5 ±6.4) min vs (61.2 ±7.3) min,P <0. 01;(6.5 ±1.3) min vs (4.2 ±0.8) min,P <0.05 ]. There was no significant difference in ICU stay time and hospitalization time between the observation group and the control group [(2.1 ±0.5) d vs (1.8 ±0.4) d,P >0.05;( 15.1 ±1.7) d vs ( 14. 9 ±2. 2) d,P >0.05 ]. Compared with control group,the serum interleukin (IL)-6 [( 1.6 ± 1.3) mg/L vs (1.9 ± 1.2) mg/L,P < 0.05 ] and chitinase-3-like protein-1 ( YKL-40)[(2.7 ± 0.5 )μg/L vs (3. 0 ±0. 6)μg/L,P <0.05 ] in the observation group were significantly lower at 6 months after operation. Six months after operation, the left atrial diameter, left ventricular end-diastolic volume and ejection fraction in the observation group were significantly different from those in the control group ( P <0. 05 ,P <0. 01). The rate of atrial fibrillation converting to sinus rhythm in observation group was significantly higher than that in control group after operation (70. 8% vs 35. 7%, P < 0. 05 ) and 6 months after operation ( 87. 5% vs 21. 4%,P < 0. 01 ). Conclusion For patients with valvular heart disease complicated with coronary heart disease and atrial fibrillation, cardiac valve replacement combined with coronary artery bypass grafting and simultaneous radiofrequency ablation of atrial fibrillation can improve cardiac function, reduce serum levels of IL-6 and YKL-40, and increase the probability of atrial fibrillation reverting to sinus rhythm.
作者
李中杰
何勇
刘光强
陈冲
曹勇
LI Zhong-jie;HE Yong;LIU Guang-qiang;CHEN Chong;CAO Yong(Department of Cardiac Surgery,The People rs Hospital of Gaozhou,Gaozhou,Guangdong 525200,China)
出处
《中国临床研究》
CAS
2019年第10期1372-1375,共4页
Chinese Journal of Clinical Research
基金
广东省医学科学技术研究基金项目(A2018475)~~
关键词
心脏瓣膜病
冠状动脉搭桥术
心脏瓣膜置换术
房颤射频消融术
同期
Valvular heart disease
Coronary artery bypass grafting
Cardiac valve replacement
Atrial fibrillation radiofrequency ablation
Simultaneous
