發(fā)布時(shí)間：2018-09-18 17:10

【摘要】：背景：心臟瓣膜手術(shù)中對(duì)患者同時(shí)采取射頻消融術(shù),至于這些能否為風(fēng)濕性心臟瓣膜病提供額外的效果目前還不清楚。我們通過前瞻性隨機(jī)對(duì)照的研究來探討射頻消融術(shù)對(duì)風(fēng)濕性心臟瓣膜病治療的效果。方法：將2008年6月至2011年7月期間的210例伴有慢性房顫和風(fēng)濕性心臟瓣膜病的患者隨機(jī)分為以下幾組：(1)對(duì)照組,該組患者在瓣膜恢復(fù)后只采取使用胺碘酮控制心律,(2)左心房組(LA組),患者在瓣膜恢復(fù)后只對(duì)左心房進(jìn)行單級(jí)射頻消融術(shù),(3)雙側(cè)心房組(BA組),患者在瓣膜恢復(fù)正常后兩側(cè)心房均采取單級(jí)射頻消融術(shù)。主要的指標(biāo)包括：心源性死亡,中風(fēng)和出院后再次出現(xiàn)房顫。結(jié)果：未出現(xiàn)圍術(shù)期死亡。在BA組中一名患者在二尖瓣置換術(shù)(MVR)4個(gè)月后死亡。由考克斯單變量分析得出,在雙側(cè)心房射頻消融組中出現(xiàn)房顫的次數(shù)較少(BA組與對(duì)照組相比,p0.001,LA組與對(duì)照組相比,p0.001),并且出現(xiàn)房性心動(dòng)過速性心律失常(AF/AT/AFL)的次數(shù)較少(BA組與對(duì)照組相比,p0.001,LA組與對(duì)照組相比,p=0.02)。BA組與LA組相比,房顫(AF)(p=0.06)或AF/AT/AFL (p=0.09)之間沒有顯著性差異。手術(shù)后12個(gè)月心房傳輸功能恢復(fù)率LA組是31.4%,BA組是32.9%,對(duì)照組是8.6%。結(jié)論：在中低風(fēng)險(xiǎn)的風(fēng)濕性心臟瓣膜疾病的治療中,與常規(guī)醫(yī)療抗心律失常藥物的治療相比,心臟瓣膜術(shù)中射頻消融術(shù)使竇性心律恢復(fù)正常的概率更大。
[Abstract]:Background: radiofrequency ablation is performed simultaneously in valvular heart surgery, but it is not clear whether these can provide additional effects for rheumatic valvular disease. We investigated the effect of radiofrequency ablation on rheumatic valvular heart disease by prospective randomized controlled study. Methods: from June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic valvular disease were randomly divided into the following groups: (1) Control group; Patients in this group were only treated with amiodarone to control heart rhythm after valve recovery, (2) left atrium group (LA group), patients underwent single stage radiofrequency ablation of left atrium after valve recovery, (3) bilateral atrium group (BA group), and patients returned to normal valve after valve recovery. Single stage radiofrequency ablation was performed on both sides of the atrium. The main indicators include cardiogenic death, stroke, and the recurrence of atrial fibrillation after discharge. Results: there was no perioperative death. In the BA group, one patient died 4 months after mitral valve replacement (MVR). By Cox's univariate analysis, Atrial fibrillation was found less frequently in the bilateral atrial radiofrequency ablation group (P 0.001) and atrial tachycardia (AF/AT/AFL) was less frequent in the BA group than in the control group (compared with the control group). BA group was compared with LA group. There was no significant difference between atrial fibrillation (AF) (p0. 06) or AF/AT/AFL (p0. 09). 12 months after operation, the recovery rate of atrial transmission function in LA group was 31.4% and that in control group was 32.9% and 8.6%, respectively. Conclusion: in the treatment of low risk rheumatic valvular disease, compared with conventional antiarrhythmic drugs, radiofrequency ablation during cardiac valve surgery has a higher probability of sinus rhythm returning to normal.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2
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本文編號(hào)：2248575