心脏瓣膜置换术联合射频消融治疗心脏瓣膜病变的临床观察

目的:探讨心脏瓣膜置换术联合不同射频消融方法治疗重度心脏瓣膜病变的效果.方法:选取2013年3月-2016年2月在解放军第1 53中心医院接受心脏瓣膜置换术联合射频消融治疗的心功能分级(NYHA标准)≥Ⅲ级的心脏瓣膜疾病患者75例为研究对象,其中接受心脏瓣膜置换联合双极射频消融者26例(双极组),心脏瓣膜置换联合单极射频消融者25例(单极组),单用心脏瓣膜置换术治疗者24例(对照组).比较各组射频消融所用时间、术后即刻窦性心律恢复情况、辅助呼吸时间、术后住院时间、围手术期病死率、心脏功能指标和心功能分级疗效.结果:双极组、单极组的术后即刻窦性心律恢复率(92.31％和88.00％比对照组70.83％)、辅助呼吸时间(16.75±2.68)h和(16.04±4.21)h比对照组(24.81±3.38) h]、术后住院时间(8.41±1.84)d和(9.01±1.72)d比对照组(11.26±2.35)d]、左室舒张末内径6个月时(47.24±5.81) mm和(46.03±6.78) mm比对照组(53.11±4.35) mm;12个月时(41.84±3.69) mm和(40.98±5.27) mm比(48.75±4.36)mm]、左室射血分数(6个月时0.483 6±0.027 9、0.495 1±0.030 2比对照组0.433 2±0.037 2:12个月时0.580 4±0.038 5、0.569 3±0.029 6比对照组0.489 1±0.038 1)、肺动脉收缩压6个月时(39.82±3.42) mmHg和(40.21±2.01) mmHg比对照组(44.92±2.44) mmHg;12个月时(35.62±2.11) mmHg和(36.63±1.92) mmHg比对照组(39.95±2.87) mmHg]、心功能疗效总有效率(88.46％和84.00％比对照组54.17％)均显著优于对照组(P＜0.05),双极组和单极组上述指标差异并无显著性(P＞0.05),但双极组消融用时(22.34±2.57) min]少于单极组(29.04±3.41) min,P＜0.05].结论:心脏瓣膜置换术联合射频消融治疗有利于改善心脏瓣膜病预后效果,双极射频消融治疗在有效性、安全性方面均优于单极射频治疗.

Observation on heart valve replacement combined with radiofrequency ablation in treatment of cardiac valve disease

Objective:To evaluate the treatment effects of cardiac valve replacement combined with radiofrequency ablation in treatment of cardiac valve disease.Methods:Seventy-five patients with cardiac valve disease admitted to the 153rd Central Hospital of PLA from Mar.2013 to Feb.2016 received cardiac valve replacement treatment.All the patients were with heart function of ≥ Ⅲ NYHA grade,of them 51 cases were treated with heart valve replacement combined with bipolar radiofrequency ablation (bipolar group,26 cases) or with unipolar radiofrequency ablation (unipolar group,25 cases),and 24 cases were treated only with cardiac valve replacement (control group).The time of radiofrequency ablation treatment,the recovery of sinus rhythm immediate postoperation,the assisted respiration time,the time of postoperative hospital stay,perioperative mortality and the improvement of cardiac function were compared between bi-and unipolar groups vs.control group.Results:Compared between bi-and unipolar groups vs.control group,the recovery rates of sinus rhythm immediate postoperation were 92.31％ and 88.00％ vs.70.83％,the assisted respiration time presented (16.75+2.68) hours and (16.04+4.21) hours vs.(24.81±3.38) hours,the time of postoperative hospital stay spent (8.41±1.84) days and (9.01±1.72) days vs.(11.26±2.35) days;As for the cardiac function indexes,the left ventricular end-diastolic dimension in 6 months were (47.24±5.81) mm and (46.03±6.78) mm vs.(53.11±4.35) mm and in 12 months were (41.84±3.69) mm and (40.98±5.27) mm vs.(48.75±4.36) mm,the left ventricular ejection fraction in 6 months were 0.483 6±0.027 9 and 0.495 1±0.030 2 vs.0.433 2±0.037 2 and in 12 months were 0.580 4±0.038 5 and 0.569 3±0.029 6 vs.0.489 1±0.038 1,the pulmonary artery systolic pressure in 6 months were (39.82±3.42) mmHg and (40.21±2.01) mmHg vs.(44.92±2.44) mmHg and in 12 months were (35.62±2.11) mmHg and (36.63±1.92) mmHg vs.(39.95±2.87) mmHg,and the total effective rates of heart function were 88.46％ and 84.00％ vs.54.17％ (all P ＜ 0.05).The indexes mentioned-above showed no significant difference between bipolar group and unipolar group (P ＞ 0.05),but the time of ablation treatment was shorter in bipolar group (22.34±2.57) minutes] than in unipolar group (29.04±3.41) minutes,P＜0.05].Conclusions:Cardiac valve replacement combined with radiofrequency ablation is beneficial to improve the prognosis of heart valve disease,and bipolar radiofrequency ablation is superior to unipolar radiofrequency ablation in effectiveness and safety.