摘要
目的评估Cox迷宫Ⅲ型手术治疗风湿性二尖瓣病变伴发心房颤动的安全性和有效性。方法1:1配比筛选出两组2007年1月至2015年7月期间在沈阳军区总医院心血管外科施行二尖瓣置换和迷宫手术治疗的风湿性二尖瓣病变伴发心房颤动病例,其中Cox迷宫Ⅳ型手术(CMⅣ组)和Cox迷宫Ⅲ型手术(CMⅢ组)各85例。比较两组手术安全性指标、病死率、并发症及窦性心律恢复率,评估Cox迷宫Ⅲ型手术治疗风湿性二尖瓣病变手术伴发心房颤动的安全性和疗效。结果CMⅢ组体外循环时间[(154±22)min比(136±21)min,P〈0.001]和主动脉阻断时间[(85±9)min比(74±12)min,P〈0.001]均长于CMⅣ组。CMⅢ组死亡1例(1.18%),死因为左心室破裂修复术后第4天发生多脏器功能衰竭;CMⅣ组死亡2例(2.35%),分别为左心室破裂1例和低心排血量综合征1例,两组比较差异无统计学意义。CMⅢ组应用临时起搏器76例(89.41%),与CMⅣ组[70例(82.35%)]比较差异无统计学意义(P=0.186)。术中尿量、术后当日引流液量、血红蛋白尿、呼吸机辅助时间、ICU时间、住院时间、常见并发症发生率等组间差异均无统计学意义(均P〉0.05)。窦性心律恢复率:术后当日CMⅢ组为62.35%,CMⅣ组为57.65%,两组比较差异无统计学意义(P=0.531);出院时分别为97.62%、81.93%,两组比较差异有统计学意义(P〈0.001)。均随访3个月,无死亡病例;CMⅢ组和CMⅣ组窦性心律分别为96.43%和86.75%,两组比较差异有统计学意义(P=0.024)。结论Cox迷宫Ⅲ型手术是治疗风湿性二尖瓣病变伴发心房颤动的安全且更有效的方法。
Objective To evaluate the safety and efficacy of cut-and-sew Cox-Maze (CM) Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease. Methods Patients received mitral valve replacement and CM procedure between January 2007 and July 2015, were 1 : 1 matched and assigned to CM Ⅳ group (undergoing surgical ablation) and CM m group (undergoing cut- and-sew CM Ⅲ) . Safety indices, mortality rate, complications and recovery rate of sinus rhythm were compared between the two groups. Results Mean extracorporeal circulation time was ( 154 ± 22) min in the CM Ⅲ group and (136±21) min in the CM IV group (P〈0.001), and aortic clamp time was (85 ±9) min in the CM m group and (74±12) min in the CM Ⅳ group (P 〈0. 001 ). One patient ( 1.18% ) in the CM Ⅲ group died of multi-organ failure 4 day after left ventrieular rupture being sucessfully repaired, and 2 patients died (2.35%) in the CM IV group ( 1 due to left ventrieular rupture and 1 due to low cardiac output syndrome ). There was no significant difference in mortality between the two groups. Temporary pacemaker were applied for 76 cases (89. 41% ) in the CM m and 70 cases (82. 35% ) in the CM IV group, without a statistical difference (P = 0. 186 ). There were also no statistical difference between the two groups in intraoperative urinary volume, postoperative drainage of fluid volume, hemoglobinuria, ventilator time, ICU time, hospital stay and the incidence of the complications ( all P 〉 0. 05 ). Sinus rhythm recovery rate was 62. 35 % in the CM Ⅲ group and 57.65 % in the CM IV group, without a statistical difference (P =0. 531 ) at the operation day, but at discharge a statistical difference was found (97.62% in the CM Ⅲ group vs 81.93% in the CM IV group, P 〈 0. 001 ). All patients were followed up for three months, and no deaths occurred. Sinus rhythm recovery rate was 96.43 % in the CM Ⅲ group and 86.75% in the CM IV group, wi
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第13期1011-1015,共5页
National Medical Journal of China
基金
辽宁省自然科学基金(2014020065)
2014年厄尔巴肯奖学金
关键词
心房颤动
消融技术
Cox迷宫手术
疗效比较研究
Atrial fibrillation
Ablation techniques
Cox maze procedure
Comparative effectiveness research