比索洛尔对持续性非瓣膜性心房颤动患者心房结构重构的影响

目的观察比索洛尔对持续性非瓣膜性心房颤动患者心房结构重构及C反应蛋白(CRP)的影响,并探讨其可能关系。方法将85例持续性非瓣膜性心房颤动患者,分为比索洛尔组(48例)和地高辛组(37例),随访观察(9.8±1.3)个月,治疗前后检测CRP和超声心动图观察左心房结构变化。结果比索洛尔组治疗后左心房内径(41.8±4.2)mmvs(39.7±5.3)mm,CRP 3.9 mg/Lvs3.5 mg/L,均较治疗前明显下降,差异有统计学意义(P<0.01),而地高辛组治疗前后左心房内径(41.8±4.6)mmvs(42.3±5.2)mm,CRP 3.8 mg/Lvs3.5 mg/L,差异无统计学意义(P>0.05)。比索洛尔组的左心房内径和CRP下降幅度与地高辛组比较,差异有统计学意义(P<0.01)。相关分析显示,左心房内径变化与CRP变化呈显著正相关(r=0.218,P=0.045)。结论比索洛尔可改善持续性非瓣膜性心房颤动患者的心房结构重构,并减轻炎性反应。     

左房内径及其有效不应期与心房颤动的关系

目的探讨左房内径(LAD)及其有效不应期(ERP)变化与心房颤动(简称房颤)的关系。方法应用彩色多普勒超声心动图仪测定151例房颤患者及160例健康体检者LAD、左室后壁厚度、室间隔厚度、射血分数(EF)值。采用食管调搏S1S2扫描的方法测定左房ERP,观察ERP频率适应性。结果房颤组LAD较对照组显著增加(38.81±9.64mmvs26.88±6.72mm),且持续性房颤患者LAD较阵发性房颤患者显著增加。房颤有左室肥厚(LVH)者LAD较非LVH者显著扩大,左房显著扩大者(≥40mm)其EF、每搏输出量下降最明显。房颤组左房ERP较对照组显著缩短,且频率适应性减退。结论LAD扩大及其电重构与房颤发生相关,LAD扩大与LVH及心功能减退有关。     

C反应蛋白增高在心房颤动中的意义

目的 :探讨C反应蛋白 (CRP)增高在心房颤动 (房颤 )发病中的意义。方法 :应用免疫比浊法测定 96例诊断为房颤患者血清CRP水平 ,与对照组比较 ,并对房颤按持续时间、病因不同分设亚组 ,进行统计学分析。结果 :房颤组、对照组血清CRP水平分别为 (4 .30± 2 .87)、(1.15± 0 .90 )mg L ,两组相比P <0 .0 5。器质性、孤立性房颤者CRP水平分别为 (5 .0 6± 1.92 )、(4 .37± 1.32 )mg L ,均高于对照组 ,P <0 .0 5。持续性、永久性房颤者CRP水平分别为 (5 .6 0± 1.80 )、(5 .0 0± 1.6 0 )mg L ,均高于阵发性房颤 [(3.30± 1.2 0 )mg L],P <0 .0 5。结论 :CRP增高反映的炎症状态可能促进房颤发生 ,以及呈持续性发作。     

心房颤动患者氨基末端脑钠肽前体水平与左心房大小的临床研究

目的探讨左心室收缩功能正常的心房颤动患者血清氨基末端脑钠肽前体(NT-proBNP)水平与左心房内径(LAD)的关系及临床意义。方法选取左心收缩功能正常的阵发性心房颤动患者31例、持续性心房颤动患者30例和永久性心房颤动患者33例,另选30名窦性心律者为对照组,比较不同类型心房颤动患者与窦性心律者血清NT-proBNP水平,并观察血清NT-proBNP水平与LAD大小的关联。结果心房颤动患者血清NT-proBNP水平较窦性心律者升高,差异有统计学意义[(305.2±170.9)ng/L比(57.2±31.9)ng/L,P<0.01]。其中持续性心房颤动组的LAD和NT-proBNP较阵发性心房颤动组均显著升高[LAD:(33.7±4.9)mm比(30.5±3.3)mm,P<0.05;NT-proBNP:(261.8±124.9)ng/L比(143.7±26.2)ng/L,P<0.05];永久性心房颤动组的LAD和NT-proBNP较阵发性心房颤动组均显著升高[LAD:(37.5±2.9)mm比(30.5±3.3)mm,P<0.05;NT-proBNP:(599.0±33.5)ng/L比(143.7±26.2)ng/L,P<0.05];永久性心房颤动组的LAD和NT-proBNP较持续性心房颤动组均显著升高[LAD:(37.5±2.9)mm比(33.7±4.9)mm,P<0.05;NT-proBNP:(599.0±33.5)ng/L比(261.8±124.9)ng/L,P<0.05]。不同类型心房颤动组的LAD越大(中位值分别为30.5、33.7和37.5 mm),患者血清NT-proBNP的水平越高(中位值分别为143.7ng/L、261.8ng/L和599.0 ng/L)多元线性逐步回归分析显示,LAD、心房颤动类型和病程是高血清NT-proBNP水平的独立预测因素(均为P<0.01)。结论在左心室收缩功能正常的不同类型心房颤动患者中,血清NT-proBNP水平明显高于窦性心律者,可能与患者心房结构重构及心房颤动类型和病程密切相关。     

阿托伐他汀对急性冠脉综合征患者血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平的影响

目的探讨阿托伐他汀干预对急性冠脉综合征(ACS)患者血清高敏C反应蛋白(hs-CRP)和妊娠相关血浆蛋白-A(PAPP-A)水平的影响。方法采用酶联免疫吸附法测定不稳定型心绞痛患者(UAP,n=37)、急性心肌梗死患者(AMI,n=24)、稳定型心绞痛患者(SAP,n=29)和健康体检者(n=32)的hs-CRP和PAPP-A水平。同时将ACS患者(包括UAP和AMI组,n=61)随机分为常规治疗组(n=30)和阿托伐他汀干预组(阿托伐他汀10mg/d,n=31),并于治疗前后分别测定血清hs-CRP和PAPP-A水平。结果(1)hs-CRP和PAPP-A水平在UAP组[(16.7±1.24)mg/L,(63.88±1.82)μg/L]、AMI组[(18.52±1.96)mg/L,(66.41±1.24)μg/L]比SAP组[(4.6±1.16)mg/L,(47.56±0.72)μg/L]、正常对照组[(3.2±0.88)mg/L,(45.17±1.28)μg/L]显著升高(P<0.05)。(2)2周后,阿托伐他汀干预组血清hs-CRP和PAPP-A水平较治疗前明显降低[hs-CRP(18.52±2.37)mg/Lvs.(3.58±1.33)mg/L;PAPP-A(67.83±2.15)μg/Lvs.(45.62±1.58)μg/L,P<0.05],且较常规治疗组治疗2周后亦有显著降低[hs-CRP(3.58±1.33)mg/Lvs.(5.23±1.98)mg/L;PAPP-A(45.62±1.58)μg/Lvs.(51.35±2.15)μg/L,P<0.05]。结论阿托伐他汀干预可以减少急性冠脉综合征患者动脉粥样硬化斑块的炎症反应,具有稳定斑块的作用。     

C反应蛋白与心房颤动的关系

目的探讨C反应蛋白(CRP)作为系统炎症因子在心房颤动发生和发展中的作用。方法入选98例患者将其分为正常对照组(n=34)、阵发性房颤组(n=31)和持续房颤组(n=33),比较各组C反应蛋白水平。结果心房颤动组CRP水平[(1.85±0.44)mg/d]比正常对照组的水平[(0.41±0.13)mg/d]高,P<0.01;在心房颤动组中持续房颤组血清中CRP[(2.02±0.54)mg/d]高于阵发性房颤组[(1.55±0.40)mg/d],P<0.01,阵发性房颤组[(2.02±0.54)mg/d]高于正常对照组(0.41±0.13)mg/dl,P<0.01。并且不同原因引起的房颤CRP不同,冠心病最高,其次为高血压,心肌病最低。结论CRP在心房颤动患者中明显升高,说明炎症状态在心房颤动的发生和持续中起一定作用。     

高敏C反应蛋白与高血压病患者合并颈动脉粥样硬化的关系

目的探讨炎症标记物高敏C反应蛋白(hs-CRP)与高血压病患者中颈动脉粥样硬化发生的关系。方法对入选的202例高血压病患者进行颈动脉超声检查测量颈总动脉内膜中层厚度(IMT)、观察有无斑块形成,并进行血清hs-CRP定量检测。根据患者颈动脉粥样硬化程度、是否合并糖尿病及吸烟情况分组进行血清hs-CRP水平比较。结果(1)合并颈动脉粥样硬化的高血压病患者血清hs-CRP显著高于无颈动脉粥样硬化患者[(4.96±5.26)mg/Lvs(3.16±3.54)mg/L,P=0.006]。(2)颈动脉斑块组患者平均血清hs-CRP显著高于颈动脉正常组患者[(5.35±4.82)mg/Lvs(3.16±3.54)mg/L,P=0.002]。(3)根据吸烟情况进行分层后,1年内有吸烟行为者中颈动脉斑块硬化组患者血清hs-CRP平均值明显高于颈动脉正常组[(5.30±5.02)mg/Lvs(3.07±1.70)mg/L,P=0.024]。(4)无糖尿病的高血压病患者中,颈动脉粥样硬化组患者血清hs-CRP均值高于颈动脉正常组[(5.03±5.35)mg/Lvs(3.25±3.61)mg/L,P=0.032]。结论合并颈动脉粥样硬化尤其有颈动脉斑块的高血压病患者血清hs-CRP显著高于无颈动脉粥样硬化患者。     

C-反应蛋白水平与周围动脉疾病的关系

目的测定血清C-反应蛋白(CRP)以预测周围动脉疾病的价值。方法对2004年12月~2006年12月收住本院的周围动脉疾病患者,分别测定各研究组的C-反应蛋白水平,比较各组间的差异。结果各组血清CRP水平:对照组为7.28±5.87mg/L,I期组为11.76±2.87mg/L,Ⅱ期组为19.87±6.29mg/L,Ⅲ期组为19.06±7.37mg/L,Ⅳ期组为19.16±7.33mg/L。对照组与其他四组对比均存在显著差异(P<0.01)。I期组与其它三组对比存在显著差异(P<0.01),而其他三组间比较没有差异性(P>0.05)。结论CRP浓度的测定可以作为周围动脉疾病的判断指标;能对无症状性周围动脉疾病做出早期诊断,指导早期治疗。     

老年脑卒中患者C反应蛋白水平变化与预后的关系

目的探讨老年卒中患者血清C-反应蛋白(CRP)水平的变化与病情严重程度和预后的关系。方法用免疫比浊法检测184例入选对象(其中老年脑梗死106例,老年脑出血78例)的CRP含量。同时选择年龄情况和其他身体一般状况与老年脑卒中患者具有可比性的老年健康者40例为健康对照组。根据脑卒中患者临床神经功能缺损程度评分标准,对脑卒中患者进行评分。患者均经CT/MRI检查确诊。结果(1)老年脑卒中患者CRP异常率为68.48%,与对照组相比具有显著差异性(P<0.01)。(2)老年脑卒中患者CRP的水平为(13.07±2.37)mg/L,与正常对照组(2.17±0.86)mg/L相比差异具有显著性(P<0.01)。(3)老年脑梗死组和脑出血组CRP水平分别为(14.06±2.17)mg/L和(10.95±2.86)mg/L,与健康对照组(2.17±0.86)mg/L有显著差异性(P<0.01),且老年脑梗死组CRP水平显著高于脑出血组(P<0.01)。(4)老年脑梗死患者大梗死灶组较小梗死灶组CRP水平升高明显,分别为(18.67±3.64)mg/L和(15.45±2.14)mg/L,差异具有显著性(P<0.01);小梗死灶组较腔隙性梗死CRP水平显著增高,分别为(15.45±2.14)和(6.93±1.02)mg/L,两者相比具有显著差异(P<0.01);(5)老年脑卒中患者依病情轻、中、重程度不同,CRP含量依次增高(P<0.01)。(6)老年脑卒中预后好转组CRP异常率50.96%,明显低于无好转组的91.25%(P<0.01)。结论老年脑卒中与CRP水平关系密切,CRP水平越高,病情越重,预后越差。CRP水平可作为老年脑卒中患者的危险预测因子,还是一个判断病情严重程度和预后的客观指标。     

美卡素和可达龙合用治疗心房颤动及对血管紧张素Ⅱ的影响

探讨美卡素和可达龙合用治疗心房颤动(简称房颤)及对血浆血管紧张素Ⅱ(AngⅡ)的影响。64例持续房颤患者随机分两组,两组均常规给予可达龙和华法令。治疗组在此基础上加用美卡素80mg,1次/日,共6个月。结果:治疗组AngⅡ较对照组明显降低(72.30±16.89ng/Lvs100.10±15.73ng/L,P<0.01)、左房较对照组明显缩小(34.10±6.73mmvs43.10±7.18mm,P<0.05)、4周房颤转复率高(83.3%vs64.3%,P<0.05)、6个月复发率低(10.0%vs23.3%,P<0.05)。结论:美卡素能预防和调整心房电重构,有益于房颤转复和维持。     

Inflammatory activation in an unselected population of subjects with atrial fibrillation: links with structural heart disease, atrial remodeling and recent onset

Previous studies investigated circulating levels of C-reactive protein (CRP) mostly in subjects with paroxysmal atrial fibrillation (AF) and lone AF (LAF). We, therefore, aimed to investigate circulating levels of CRP in patients with new onset AF with particular regards to AF duration, even in the presence of structural heart disease (SHD). CRP levels were evaluated in 96 consecutive patients with new onset AF (50 with LAF and 46 with SHD, 41 with paroxysmal AF (PAF) (<7 days) and 55 persistent AF (>7 days). Patients with AF had higher CRP levels than controls (4.8 ± 6.99 vs. 1.59 ± 1.32 mg/L; p < 0.001). AF patients with SHD had higher CRP levels than LAF patients (7.08 ± 9.19 vs. 2.63 ± 2.47 mg/L; p < 0.01) and control subjects (vs. 1.59 ± 1.32 mg/L; p < 0.001): CRP levels in LAF patients were higher than in controls (p < 0.01). CRP levels were significantly increased in subjects with paroxysmal AF (6.67 ± 9.44 mg/L) with respect to those with persistent AF (3.54 ± 4.44 mg/L, p < 0.05) and controls (1.59 ± 1.32 mg/L, p < 0.001 vs. paroxysmal AF, p < 0.01 vs. persistent AF). Differences related to the presence of LAF and SHD remained significant even after multivariable regression analysis. CRP concentrations significantly correlated with left atrial size(r 0.23, p < 0.05). Increased CRP levels are detectable in patients with AF, proportional to atrial remodeling, recent onset of dysrhythmia and SHD.     

Relation of C-reactive protein to long-term risk of recurrence of atrial fibrillation after electrical cardioversion

The aim of this study is to assess the role of C-reactive protein (CRP) in predicting long-term risk of atrial fibrillation (AF) recurrence after electrical cardioversion. CRP levels are associated with the presence of AF and failure of electrical or pharmacologic cardioversion, but no previous study has assessed their predictive role in long-term follow-up after successful electrical cardioversion. One hundred two consecutive patients (age 67 +/- 11 years; 58 men) with nonvalvular persistent AF who underwent successful biphasic electrical cardioversion were studied. High-sensitivity CRP was measured immediately before cardioversion. Follow-up was performed up to 1 year in all cases. Patients were divided into 4 groups according to CRP quartiles. Patients in the lowest CRP quartile (<1.9 mg/L) had significantly lower rates of AF recurrence (4% vs 33% at 3 months in the other 3 groups combined, p = 0.007, and 28% vs 60% at 1 year, p = 0.01). The 4 groups were similar in age, gender, ejection fraction, and left atrial size. Survival analysis confirmed that patients in the lowest CRP quartile had a lower recurrence rate (p = 0.02). Cox regression analyses using age, gender, hypertension, diabetes, ejection fraction, left atrial diameter, use of antiarrhythmic drugs, angiotensin-converting enzyme inhibitors or angiotensin II antagonists, and statins, and CRP quartiles as covariates showed that only CRP was independently associated with AF recurrence during follow-up (hazard ratio 4.98, 95% confidence interval 1.75 to 14.26, p = 0.003). In conclusion, low CRP is associated with long-term maintenance of sinus rhythm after cardioversion for nonvalvular AF.     

C-反应蛋白水平与冠脉支架术后心血管事件和再狭窄的相关性研究

目的探讨血清C反应蛋白(CRP)对支架术后6个月内心血管事件和1年内再狭窄的相关预测价值。方法对62例单支病变行冠状动脉支架植入术患者术后72小时测定血清CRP水平并记录患者术后3天至6个月来心血管事件(心绞痛、心肌梗死及死亡)及1年来支架内再狭窄情况。结果发生心血管事件组CRP水平明显高于未发生组(9.65±2.98mg/LVS7.53±2.76mg/L,P<0.05),CRP增高组与CRP正常组心血管事件发生率相似(18.0%VS8.3%P>0.05),血清CRP水平与冠脉支架术后6～12个月再狭窄无显著差异(7.58±2.16mg/LVS7.21±2.34mg/L,P>0.05;14.6%VS16.7%,P>0.05)。结论冠脉支架术后发生心血管事件与CPR水平明显相关,术后再狭窄与CPR水平无显著相关性。     

Eicosapentaenoic acid for the prevention of recurrent atrial fibrillation

Background: n‐3 polyunsaturated fatty acids, primarily eicosapentaenoic acid (EPA), has been reported to have antiarrhythmic and antiinflammatory effects. The aim of the present study was to examine whether the combination of antiarrhythmic drugs and EPA reduced the frequency of atrial fibrillation (AF) in patients with paroxysmal AF. Methods: We studied 50 patients with paroxysmal AF (age, 54 ± 9 years) after excluding the clinical conditions associated with an increased risk of AF. Patients were initially treated with antiarrhythmic drugs for 6 months (the observation period), and thereafter, EPA was added at a dose of 1.8 g/day for 6 months (the intervention period). During a one‐year period, patients obtained an ECG recording using a portable device each morning and when arrhythmia‐related symptom occurred. The end point was the difference of the AF burden (defined by the days of AF per month) between observation period and intervention period. Plasma EPA and C‐reactive protein (CRP) levels were also determined. Results: There was no significant difference in the AF burden before and after intervention (2.6 ± 2.2 days/months vs. 2.5 ± 2.2 days/months, P = 0.45). Although EPA level was significantly increased (42 ± 15 μg/mL to 120 ± 47 μg/mL, P < 0.001), CRP level was unchanged (1.04 ± 0.69 mg/L to 0.96 ± 0.56 mg/L, P = 0.24) following EPA treatment. Conclusions: Treatment of EPA in combination with antiarrhythmic drugs did not reduce the AF burden or the CRP levels in paroxysmal AF patients who had no evidence of substantial structural heart disease. Ann Noninvasive Electrocardiol 2011;16(4):373–378     

老年心房颤动患者左心房内径及其电活动变化的临床研究

目的探讨老年心房颤动(房颤)患者左心房内径、电活动变化及其意义。方法142例老年非瓣膜性房颤患者(房颤组)进行彩色多普勒超声心动图仪及三导心电图仪检查,测定左心房内径(LAD)、左心室舒张期末内径、左心室后壁厚度、室间隔厚度、左心室射血分数(LVEF)及房颤的检出。采用食管调搏的方法测定左心房电生理特性,以400ms起搏周长(PCL)对左心房进行S1S2扫描,测定基础状态左心房有效不应期(LAERP);以3种不同起搏周长(400、500、600ms)对左心房进行S1S2扫描,观察LAERP频率适应性。150例健康体检者为正常对照组。结果房颤组患者LAD较正常对照组显著增加,其中左心房扩大(LAD>32mm)者占95.07%,且持续性房颤患者LAD较阵发性房颤患者显著增加。左心室肥厚患者LAD较无左心室肥厚患者显著扩大,左心房扩大与心功能降低有关,其中左心房显著扩大者(LAD≥40mm)其LVEF、每搏输出量下降最明显。房颤组患者LAERP较正常对照组显著缩短,LAERP频率适应性较正常对照组减退。结论LAD扩大及其电重构与房颤发生密切相关,LAD扩大与左心室肥厚及心功能减退有关。     

左心房内径与高龄心房颤动并缺血性卒中的相关性分析

目的 左心房内径与高龄心房颤动并缺血性卒中的相关性。方法 选取2015.01~2018.08在南部战区总医院干部病房住院的高龄患者共524例,房颤患者264例,其中持续性房颤132例(25.2%),阵发性房颤132例(25.2%),非房颤患者260例(49.6%)。通过病历资料,调取超声心动图检查结果,比较左心房内径在房颤组与非房颤组之间、房颤卒中组与非房颤卒中组之间是否存在差异。结果 与非房颤组相比,房颤组左心房左右内径(43.87±8.20mm vs 38.06±4.50mm, P=0.001)、左心房前后内径(37.96±7.24mm vs 33.54±4.51mm, P=0.001)、左心房上下内径(44.98±7.25mm vs 43.00±7.59mm, P=0.001)、右心房前后内径(53.09±6.65mm vs 48.71±7.14mm, P=0.001)、肌酐(124.42±88.20umol/L vs 110.01±48.39umol/L, P=0.023)、胱抑素C(1.97±1.22mgl/L vs 1.63±0.62mgl/L, P=0.001)、尿酸(400.13±121.34umol/L vs 378.71±118.47umol/L, P=0.043)、同型半胱氨酸(16.80±11.58umol/L vs 14.87±5.84umol/L, P=0.017)、低密度脂蛋白(1.79±0.65mmol/L vs 2.01±0.76mmol/L, P=0.001)、甘油三酯(3.38±0.88mmol/L vs 3.66±0.99mmol/L, P=0.001)、缺血性卒中(136/128 vs 78/182, P=0.001)、慢性心力衰竭(141/123 vs 69/191, P=0.001)等指标在两组之间差异有统计学意义。房颤卒中组尿酸(385.65±122.37umol/L vs 415.28±118.83umol/L, P=0.047)、左心房左右内径(44.71±7.83mm vs 42.72±8.47mm, P=0.049)、左心房上下内径(45.45±6.87mm vs 43.18±7.69mm, P=0.012)、慢性心力衰竭(81/55 vs 60/68, P=0.048)等指标与非房颤卒中组比较,差异有统计学意义。通过Logistic回归分析发现,左心房左右内径、左心房上下径、慢性心力衰竭可能与高龄房颤并缺血性卒中存在关联性,左心房左右内径、左心房上下径可作为高龄房颤并缺血性卒中的预测因子,ROC曲线下面积分别为0.596、0.588。结论 左心房内径不仅与高龄房颤并发缺血性卒中存在关联性,也可作为高龄房颤并发缺血性卒中的预测因子。     

Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion

INTRODUCTION AND OBJECTIVES: Atrial remodeling is responsible for the early recurrence of atrial fibrillation (AF) after cardioversion. Recently, it has been shown that the C-reactive protein (CRP) level is elevated in patients with AF, indicating that inflammation may play a role in the pathogenesis of this arrhythmia. We postulated that a high CRP level would predict early recurrence of AF after electrical cardioversion. PATIENTS AND METHOD: Forty-two patients with persistent AF, but without known heart disease, who underwent elective electrical cardioversion were investigated. The CRP level was measured immediately before cardioversion. The study population comprised the 37 patients in whom sinus rhythm was restored. RESULTS: After a follow-up period of 30 days, 16 patients (43%) had recurrence of AF; the other 21 (57%) remained in sinus rhythm. The mean CRP level was significantly higher in patients with AF recurrence (6.3 [3.3] mg/L vs 2.4 [2.1] mg/L, P=.0001). On dividing patients according to whether their CRP level was < or =3 mg/L or >3 mg/L, it was observed that only 33% of those in sinus rhythm had a level >3 mg/L compared with 81% of those with AF recurrence (P=.004). Patients with a CRP level >3 mg/L had a significant increase in the 1-month risk of AF recurrence (RR=3.7; 95% CI, 1.3-10.8). There was no association between CRP level and left atrial diameter (P =.50) or AF duration (P=.458). CONCLUSIONS: A high CRP level is associated with early recurrence of AF after electrical cardioversion, suggesting that inflammation could play a role in atrial remodeling.     

风湿性心脏瓣膜病慢性心房颤动左房迷宫术五年随访

评价左房迷宫手术对风湿性心脏瓣膜病慢性心房颤动 (简称房颤 )治疗及心脏功能的远期影响。15例风湿性心脏瓣膜病伴慢性房颤同期施行心脏瓣膜手术和在心外膜标测指导下的左房迷宫手术 ,随访 5 9.2± 7.9个月。结果 :①心脏复跳后心外膜双房标测 11例显示窦性激动 ,4例为心房扑动。②术后 3个月 ,1,3,5年维持窦性心律者分别为 6 7% (10 / 15 ) ,80 % (12 / 15 ) ,86 .6 % (13/ 15 ) ,92 .8% (13/ 14 ) ,且不用任何抗心律失常药。③ 2例因窦性停搏 >3s ,安置永久起搏器。④随访期间左房容积 (76 .0 6± 2 0 .2 3cm3 vs 10 5 .5 1± 33.79cm3 ,P <0 .0 5 )、左房舒张内径(2 .79± 0 .5cmvs 3.6 7± 1.10cm ,P <0 .0 5 )、左室舒张内径 (4 .36± 0 .2 9cmvs4 .6 3± 0 .4 9cm ,P <0 .0 5 )、左室舒张末期容积 (86 .6 1± 14 .5 0cm3 vs 10 3.80± 2 4 .4 8cm3 ,P <0 .0 5 )、心输出量 (4 .6 0± 1.35L/minvs 5 .6 6± 0 .0 5L/min ,P <0 .0 5 )均明显小于术后。随访期射血分数 0 .6 6± 0 .0 7,左室内径短轴缩短率 35 .98%± 5 .39%。左房有收缩功能 87% ,右房有收缩功能 93%。⑤随访期再住院率 2 6 .6 %。结论 :风湿性心脏瓣膜病在换瓣同时进行左房迷宫术能安全有效的消除房颤 ,改善心脏功能和结构。