摘要
目的探讨心脏瓣膜手术单独或同期行房颤射频消融术或进一步联合左心耳夹闭术分别在预防心源性脑卒中的临床效果以及手术安全性。方法回顾性分析临汾市人民医院胸外科与西安西京医院心脏外科于2015年3月至2021年8月期间收治的45例瓣膜性心脏病合并房颤患者的临床资料。其中男性21例,女性24例,平均年龄(62.3±7.7)岁。永久性房颤患者19例,持续性房颤患者22例,阵发性房颤患者4例。结果围手术期无死亡,18例行单独瓣膜置换手术,12例行瓣膜置换手术+射频消融术,15例行瓣膜置换+射频消融+左心耳夹联合手术。单独瓣膜置换平均手术时间(241.00±26.55)min,瓣膜置换手术+射频消融术平均手术时间(275.50±12.69)min,瓣膜置换+射频消融+左心耳夹联合手术平均手术时间(298.33±19.92)min。术后即刻转窦性心律36例(4/5),9例未转窦(1/5)。左心耳夹位置良好无移位(15例,100%)。单纯瓣膜手术组和瓣膜手术+射频消融组术后脑卒中发生各1例,瓣膜置换+射频消融+左心耳夹联合手术组术后无脑卒中发生。单纯瓣膜手术组术后出现1例胸腔积液患者和1例出血患者;瓣膜手术+射频消融组术后出现1例出血患者;瓣膜置换+射频消融+左心耳夹联合手术组术后未出现并发症。结论心脏瓣膜手术同期行房颤射频消融术及左心耳夹闭术显著降低了脑卒中的发生率,术后的并发症发生率未受手术的复杂度增加而影响,具有安全高效的特点。
Objective To investigate the clinical efficacy and safety of heart valve surgery alone or simultaneously with atrial fibrillation radiofrequency ablation or further combined with left atrial appendage clipping in the prevention of cardiogenic stroke.Methods The clinical data of 45 patients with valvular heart disease complicated with atrial fibrillation treated at the Department of Thoracic Surgery of Linfen people's Hospital and the Department of Cardiac Surgery of Xi'an Xijing Hospital from March 2015 to August 2021 were analyzed retrospectively.There were 21 males and 24 females,with an average age of(62.3±7.7)years.There were 19 patients with permanent atrial fibrillation,22 with persistent atrial fibrillation,and 4 with paroxysmal atrial fibrillation.Results There was no death during the perioperative period.Eighteen cases underwent valve replacement alone,12 underwent valve replacement+radiofrequency ablation,and 15 underwent valve replacement+radiofrequency ablation+left atrial appendage clipping.The average operation time of single valve replacement was(241.00±26.55)min,that of valve replacement+radiofrequency ablation was(275.50±12.69)min,and that of valve replacement+radiofrequency ablation+left atrial appendage clipping was(298.33±19.92)min.Thirty-six cases(4/5)had sinus rhythm immediately after operation,and 9(1/5)had no sinus rhythm.The position of left atrial appendage clipping was good without displacement(15 cases,100%).There were 1 case of postoperative stroke in the simple valve operation group and 1 case in the valve operation+radiofrequency ablation group.There was no stroke in the valve replacement+radiofrequency ablation+left atrial appendage clipping group.One patient each developed pleural effusion and bleeding in the simple valve operation group.In the valve operation+radiofrequency ablation group,there was 1 patient with bleeding after operation.There were no postoperative complications in the valve replacement+radiofrequency ablation+left atrial appendage clipping operation group.Conclusion Cardiac valve surgery combined with atrial fibrillation radiofrequency ablation and left atrial appendage clipping can significantly reduce the incidence of stroke.The incidence of postoperative complications is not affected by the increase of surgical complexity.The combination therapy is safe and efficient.
作者
王振东
李赟
姜灵凯
王婷
刘洋
Wang Zhendong;Li Yun;Jiang Lingkai;Wang Ting;Liu Yang(Department of Thoracic Surgery,Linfen People's Hospital,Linfen 041000,China;Department of Cardiac Surgery,Xi'an Xijing Hospital,Xi'an 710032,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2023年第2期142-148,共7页
Chinese Journal of Clinicians(Electronic Edition)
基金
陕西省创新人才推进计划(2020TD-034)
临汾市卫生计生委科研项目(2017192)
关键词
结构性心脏病
心房颤动
心源性脑卒中
左心耳夹闭术
Structural heart disease
Atrial fibrillation
Cardiogenic stroke
Left atrial appendage clipping
