心脏瓣膜置换术同期冲洗式射频消融术效果观察

目的观察瓣膜置换手术同期冲洗式射频消融术对慢性房颤的临床治疗效果。方法对31例心脏瓣膜病患者行瓣膜置换手术同期冲洗式射频消融术，观察手术前后左房变化、术后心电图变化、术后引流量、术后血制品用量等。结果本组患者平均转机时间（105．86±20．88）min，平均阻断时间（60．71±16．57）min，与我院同期心脏瓣膜置换手术比较差异无统计学意义（P〉0．05）；术后13例（41．9％）需临时起搏器维持心率，均于术后12h～12d恢复自主心律（房颤或窦性心律）；术后随访6～21个月，平均（15．6±3．7）个月，术后1个月，14例（14／31）恢复窦性心律，术后1年，20例（20／27）恢复窦性心律。术后1个月随访恢复窦性心律的14例（转复组）与未复律的17例（房颤组）比较，两组术前左房内径、术后左房内径／术前左房内径差异有统计学意义（P〈0．05）。结论心脏瓣膜置换术同期冲洗式射频消融术是治疗心脏瓣膜病患者慢性房颤的有效、安全手段。

Operative results after valve replace operation combined with saline-irrigated radiofrequency modified Maze procedure

Objective To observe the operative results after valve replace operation combined with saline - irrigated radiofrequeney modified Maze procedure. Methods Thirty - one patients underwent valve replace operation combined with saline - irrigated radiofrequeney modified Maze procedure during March 2003 to June 2005. Drainage amount after surgery, amount of blood transfusion, changes of EKG and left atrium size were observed perioperatively. Results In the patients of this group, operating time was not significantly prolonged as compared with those undergoing valve replace operation. All patients were followed up for 6 -21 months （ mean 15.6 ± 3.7 months）. Temporatory pacemaker was needed in 13 eases （41.9%） ,but spontaneously cardiac rhythm recovered by the twelfth day after surgery. Sinus rhythm recovered in 14 eases （45.2%） 1 month after surgery,and sinus rhythm was seen in 20 eases one year after surgery. Conclusion Valve replace operation combined with saline - irrigated radiofrequency modified Maze procedure is a safe and efficient method to patients with valvular disease of the heart and atrial fibrillation.