米怀雪, 张申, 田飞飞, 吴联合, 盛存见, 张正升. 同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术的临床疗效[J]. 心脏杂志, 2019, 31(2): 181-185. DOI: 10.12125/j.chj.201806064
    引用本文: 米怀雪, 张申, 田飞飞, 吴联合, 盛存见, 张正升. 同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术的临床疗效[J]. 心脏杂志, 2019, 31(2): 181-185. DOI: 10.12125/j.chj.201806064
    Huai-xue MI, Shen ZHANG, Fei-fei TIAN, Lian-he WU, Cun-jian SHENG, Zheng-sheng ZHANG. Experience of heart valve replacement combine with coronary artery bypass grafting surgical treatment[J]. Chinese Heart Journal, 2019, 31(2): 181-185. DOI: 10.12125/j.chj.201806064
    Citation: Huai-xue MI, Shen ZHANG, Fei-fei TIAN, Lian-he WU, Cun-jian SHENG, Zheng-sheng ZHANG. Experience of heart valve replacement combine with coronary artery bypass grafting surgical treatment[J]. Chinese Heart Journal, 2019, 31(2): 181-185. DOI: 10.12125/j.chj.201806064

    同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术的临床疗效

    Experience of heart valve replacement combine with coronary artery bypass grafting surgical treatment

    • 摘要:
        目的  总结同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术治疗心脏瓣膜病、冠心病及房颤患者的临床疗效。
        方法  选取手术治疗的心脏瓣膜病、冠心病并发房颤患者188例的临床资料,由患者及其家属自愿选择是否同期实施房颤射频消融术。分为同期消融组(n=96)和非消融组(n=92)。同期消融组患者行同期心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术,非消融组患者仅进行心脏瓣膜手术和冠脉搭桥术。通过对比两组患者体外循环转机时间、主动脉阻断时间、呼吸机插管时间、心外科ICU监护时间和术后普通病房住院时间,出院后随访12个月,根据随访结果,记录术后6个月、12个月窦性心律转复率、心功能指标;12个月内主要心血管不良事件(MACCE,包括恶性心律失常、充血性心力衰竭、脑血管栓塞)发生率,评价其临床疗效。
        结果  体外循环转机时间,主动脉阻断时间,差异有统计学意义(P<0.05);两组呼吸机插管时间,心外科ICU监护时间和术后普通病房住院时间,差异无统计学意义;术后6个月、12个月窦性心律转复率,同期消融组优于非消融组(P<0.05),患者术后6个月、12个月心功能指标(左心房内径、NT-proBNP、左室射血分数),同期消融组优于非消融组(P<0.05);同期消融组12个月内MACCE发生率显著低于非消融组(P<0.05)。
        结论  对同时患心脏瓣膜病、冠心病及房颤患者,同期实施心脏瓣膜手术、冠脉搭桥手术及双极房颤射频消融手术,窦性心律转复率更高,临床疗效更好。

       

      Abstract:
        AIM  To summarize the clinical effects of cardiac valvular surgery, coronary bypass surgery and bipolar atrial fibrillation radiofrequency ablation for patients with valvular heart disease, coronary heart disease and atrial fibrillation.
        METHODS  The clinical data of 188 patients with heart valvular disease, coronary heart disease combined with atrial fibrillation were selected. the patients and their families voluntarily chose whether or not to perform atrial fibrillation radiofrequency ablation at the same time. They were divided into the concurrent ablation group (n=96) and the non-ablation group (n=92). At the same time, patients in the concurrent ablation group underwent valvular surgery, coronary artery bypass grafting and radiofrequency ablation of bipolar atrial fibrillation, while patients in the non-ablation group underwent valvular surgery and coronary artery bypass grafting only. By comparing the time of cardiopulmonary bypass, the time of aortic occlusion, the time of ventilator intubation, the ICU monitoring time in the heart surgery and the time of hospitalization in the ordinary ward after the operation, the follow-up was 12 months after discharge. According to the follow-up results, the rate of sinus rhythm and cardiac function were recorded in 6 months and 12 months after the operation, the incidence of major cardiovascular adverse events (MACCE, including malignant arrhythmias, congestive heart failure, cerebral vascular embolism) within 12 months was recorded, and evaluated its clinical efficacy.
        RESULTS  The time of extracorporeal circulation and aorta interruption time: P<0.05, the difference between the two groups was statistically significant;there was no significant difference between the two groups in Ventilator intubation time, ICU monitoring time of cardiac surgery and hospitalization time of general ward after operation;the rate of sinus rhythm conversion in 6 months and 12 months after the operation: the concurrent ablation group was better than the non-ablation group (P<0.05); the cardiac function index (left atrium diameter, NT-proBNP, left ventricular ejection fraction) in 6 months and 12 months after operation: the concurrent ablation group was better than the non-ablation group (P<0.05), The incidence of MACCE in the concurrent ablation group was significantly lower than that in the non-ablation group in 12 months (P<0.05).
        CONCLUSION  For patients suffering from valvular heart disease, coronary heart disease and atrial fibrillation, the rate of sinus rhythm is higher and the clinical effect is better by coronary bypass surgery, valve surgery and bipolar atrial fibrillation radiofrequency ablation.

       

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