射频消融同期行左心房减容术对风湿性瓣膜病合并心房颤动患者临床疗效及生活质量的影响

目的:探讨在风湿性瓣膜病合并心房颤动患者中于瓣膜置换术后同期实施心脏直视射频消融及左心房减容术的效果。方法:回顾性分析2014年1月至2018年12月,我院收治的风湿性瓣膜病合并心房颤动患者共95例的临床资料,将42例瓣膜置换术后同期行心脏直视射频消融术的患者纳入对照组,将53例瓣膜置换术后同期行心脏直视射频消融及左心房减容术的患者纳入观察组。比较两组患者主动脉阻断时间、体外循环时间、辅助呼吸时间、ICU治疗时间及住院时间;围手术期并发症发生情况;出院时及术后6个月心房颤动复发情况;手术前及术后6个月LVEF、左心房内径(LAD)、LVEDD及心胸比(C/T);手术前及术后6个月健康调查简表(SF-36)身体机能、生理职能、躯体疼痛、健康状况及精力状况维度得分。结果:观察组患者的主动脉阻断时间及体外循环时间均高于对照组患者(P<0.05),两组患者辅助呼吸时间、ICU治疗时间及住院时间相比较,差异无统计学意义(P>0.05)。两组患者围手术期并发症总发生率相比较,差异无统计学意义(P>0.05)。出院时两组患者心房颤动复发率差异无统计学意义(P>0.05),术后6个月观察组患者心房颤动复发率低于对照组患者(P<0.05)。术后6个月,观察组患者LVEF高于对照组患者及手术前(P<0.05),LAD、LVEDD及C/T均低于对照组患者及手术前(P<0.05);观察组患者SF-36量表身体机能、生理职能、躯体疼痛、健康状况及精力状况维度得分均高于对照组患者及手术前(P<0.05)。结论:在风湿性瓣膜病合并心房颤动患者中于瓣膜置换术后同期实施心脏直视射频消融及左心房减容术,不影响患者术后的恢复,且术式相对安全稳定,能够缩小患者左心房、改善患者心功能、减少疾病症状、降低心房颤动复发率,可以改善患者的生活质量、促进患者的康复。

Effect of left atrial plication with radiofrequency ablation on clinical efficacy and life quality of patients with rheumatic heart valve disease complicated with atrial fibrillation

Objective:To explore the effect of left atrial plication with radiofrequency ablation in patients with rheumatic heart valve disease complicated with atrial fibrillation during valve replacement at the same period.Methods:Retrospective analysis the clinical data of 95 patients with rheumatic heart valve disease complicated with atrial fibrillation admitted to our hospital from January 2014 to December 2018.42 patients who underwent valve replacement and radiofrequency ablation were included in the control group,and the other 53 patients who underwent valve replacement,radiofrequency ablation and left atrial plication were included in the observation group.Aorta occlusion time,extracorporeal circulation time,auxiliary breathing time,ICU treatment time and hospitalization time were compared between the two groups.Complications in the perioperative period were compared between the two groups.The recurrence of AF was compared between the two groups at the time of discharge or 6 months after surgery.LVEF,left atrial diameter(LAD),LVEDD and cardiothoracic ratio(C/T)were compared between the two groups before and 6 months after surgery.Physical functioning,role-physical,bodily pain,general health and vitality of SF-36 in the two groups were compared before and 6 months after surgery.Results:Aorta occlusion time and extracorporeal circulation time of the patients in the observation group were higher than those in the control group(P<0.05),and there were no statistical differences in auxiliary breathing time,ICU treatment time and hospitalization time between the two groups(P>0.05).There was no statistical difference in the total incidence of complications in perioperative period between the two groups(P>0.05).There was no statistical difference in the recurrence rate of AF between the two groups at discharge(P>0.05),while the recurrence rate of AF in the observation group was lower than that in the control group 6 months after surgery(P<0.05).6 months after surgery,the LVEF of patients in the observation group was higher than those in the control group and before surgery(P<0.05),and the LAD,LVEDD and C/T were lower than those in the control group and before surgery(P<0.05).The scores of physical functioning,role-physical,bodily pain,general health and vitality of the SF-36 scale in the observation group were all higher than those in the control group and before surgery(P<0.05).Conclusions:In patients with rheumatic heart valve disease complicated with atrial fibrillation,left atrial plication with radiofrequency ablation during valve replacement at the same period,has a significant effect,which do not affect patients with postoperative recovery,and the operation security and stability,can effectively reduce patients left atrium,improve heart function,reduce symptoms,reduce the recurrence rate of AF,improve quality of life of patients and promote the recovery of patients.