二尖瓣置换术后房颤自动复律因素的临床研究

目的探讨风湿性心脏病心房颤动患者二尖瓣置换术后自动恢复窦性心律的临床因素及护理要点。方法选择由同组医师施行的二尖瓣置换术患者178例，按照术后自动恢复窦性心律情况分为房颤组及自动恢复窦律组，对年龄、性别、左房内径、房颤时间、左室射血分数（EF值）、心胸比、心脏病史、体外循环时间及主动脉阻断时间等指标进行比较分析。结果左心房直径小于55mm的患者窦性心律转复率（43％）明显高于左心房大于55mm的患者（21％，P〈0．05）。房颤时间短于2年的患者48％转为窦性心律，明显高于房颤时间长于2年的患者（P〈0．05）。心胸比率〈0．6的患者窦性心律转复率（38％）明显高于心胸比率〉0．6者（14％，P〈0.05）。性别、年龄、左心室射血分数、有无心脏手术史、手术中体外循环时间及主动脉阻断时间对于手术后窦性心律的恢复没有影响。结论风心病二尖瓣置换术后房颤自动恢复窦性心律情况与左房大小、房颤时间及心胸比有密切关系。

Clinical Study on Factors Influencing Self-Recovery to Sinus Rhythm after Mitral Valve Replacement

Objective To investigate clinical factors influencing self-recovery to sinus rhythm after mitral valve replacement in patients with rheumatic heart disease complicated by atrial fibrillation. Methods 178 patients with mitral valve replacement （MVR） performed same surgeons were separated into two groups： Group with artial fibrillation and Group with self-recovery to si- nus rhythm. The age, sex, left atrial diameter（ LAD）, atrial fibrillation （AF） time, ejective fraction （ EF）, ratio of heart and breast （ROHB）, history of heart disease, cardiopulmonary bypass （CPB） time and aortic artery interdiction （AI） time were analyzed. Results The sinus rhythm recovery ratio of patients with LAD 〈 55 mm （43%） was evidently higher than that of patients with LAD I〉 55 mm （21% ）, P 〈 0.05. The recovery ratio （48%） of patients with A F 〈 2 years was significantly higher than the ratio of patients AF≥2 years（P 〈0.05） ,and the ratio of patients with ROHB 〈0.6（38% ） was higher than that of patients with ROHB ≥0.6 （ 14% ）, P 〈 0.05. It was not of remarkably influence on the sinus rhythm recovery of post-operation than age, sex, EF, his- tory of heart operative, CPB time, and AI time（ P all 〉 0.05 ）. Conclusions There exist significantly relationships among the si- nus rhythm recovery and the LAD, AF and ROHB for the post-MVR patients with rheumatic heart disease.