吉林大学学报(医学版) ›› 2020, Vol. 46 ›› Issue (6): 1298-1303.doi: 10.13481/j.1671-587x.20200630

• 临床医学 • 上一篇    下一篇

瓣膜置换联合射频消融和左心耳闭合术治疗心脏瓣膜病并发房颤患者的临床效果

魏玉磊1,崔玉环2,韩波3,王大伟1,王贵刚1,李倩1,曾文4   

  1. 1.河北北方学院附属第一医院胸心外科,河北 张家口 075000
    2.河北北方学院附属第一医院老年科,河北 张家口 075000
    3.内蒙古包钢医院心胸外科,内蒙古 包头 014000
    4.北京安贞医院心外科,北京 100029
  • 收稿日期:2020-04-19 出版日期:2020-11-28 发布日期:2022-08-24
  • 通讯作者: 魏玉磊
  • 作者简介:魏玉磊(1982-),男,河北省张家口市人,主治医师,医学硕士,主要从事心脏瓣膜病和房颤的外科治疗方面的研究。
  • 基金资助:
    河北省卫健委医学科学研究重点课题计划项目资助课题(20170772)

Clinical effect of valve replacement combined with radiofrequency ablation and left atrial appendage closure in treatment of valvular heart disease complicated with atrial fibrillation

Yulei WEI1,Yuhuan CUI2,Bo HAN3,Dawei WANG1,Guigang WANG1,Qian LI1,Wen ZENG4   

  1. 1.Department of Cardiothoracic?Surgery,First Affiliated Hospital,Hebei North University,Zhangjiakou 075000,China
    2.Department of Geriatrics,First Affiliated Hospital,Hebei North University,Zhangjiakou 075000,China
    3.Department of Cardiothoracic?Surgery,Inner Mongolia Baogang Hospital,Baotou 014000,China
    4.Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China
  • Received:2020-04-19 Online:2020-11-28 Published:2022-08-24
  • Contact: Yulei WEI

摘要: 目的

研究心脏瓣膜病并发心房纤颤(房颤)患者在接受瓣膜置换联合射频消融和左心耳闭合术术后心功能指标变化、血液中相关因子水平变化及脑梗死等并发症的发生情况。

方法

回顾性分析心脏瓣膜病并发房颤128例患者临床资料,根据治疗方式分为二尖瓣瓣膜置换联合射频消融和左心耳闭合术治疗组(联合手术组)与二尖瓣瓣膜置换治疗组。检测2组患者的窦性转复率、心功能指标和并发症情况,血液中白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和同型半胱氨酸水平,评估患者的预后情况。

结果

手术结束时及术后3个月、术后6个月、术后1年联合手术组患者窦性转复率均明显高于二尖瓣瓣膜置换治疗组(P<0.01)。二尖瓣瓣膜置换治疗组与联合手术组患者术前心功能指标比较差异无统计学意义( P>0.05);术后1年,与二尖瓣瓣膜置换治疗组比较,联合手术组患者左房内径(LAD)和左室舒末内径(LVEDD)均降低( P<0.05),射血分数(EF)升高(P<0.05),并发症发生率降低(P<0.05),血液中IL-1β、IL-6和TNF-α及同型半胱氨酸水平降低( P<0.01)。

结论

瓣膜置换联合射频消融和左心耳闭合术治疗瓣膜病并发房颤患者取得良好效果,能够更好地改善患者心功能,降低炎性细胞因子和同型半胱氨酸水平,降低脑梗死和出血的发生率,提高患者生存质量。

关键词: 瓣膜置换, 射频消融, 左心耳闭合, 炎性因子, 同型半胱氨酸, 脑卒中

Abstract: Objective

To study the changes of cardiac function indexes, changes of related factors levels in blood and complications such as cerebral infarction in the patients with valvular disease complicated with atrial fibrillation after valve replacement combined with radiofrequency ablation and left atrial appendage closure.

Methods

The clinical data of 128 patients were retrospectively analyzed and the patients were divided into two groups according to the patient’s operation types: mitral valve replacement combined with radiofrequency ablation and left atrial appendage closure treatment group (combined surgery group) and mitral valve replacement treatment group.The sinus rhythm restoration rates, cardiac function indexes, complications, levels of interleukin-1β (IL-1β), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) and homocysteine in blood of the patients in two groups were detected, and the prognosis was evaluated.

Results

Compared with mitral valve replacement treatment group, the sinus rhythm restoration rates of the patients in combined surgery group in the end of surgery, three months, six months and one year after surgery were increased (P<0.01). There were no significant differences in the preoperative cardiac function indexes of the patients between mitral value replacement treatment group and combined surgery group (P>0.05). One year after surgery,compared with mitral value replacement treatment group, the left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) of the patients in combined surgery group were decreased(P<0.05), the ejection fraction (EF) was increased(P<0.05),the incidence rates of complications were deceased (P<0.05), and the levels of IL-1β, IL-6, TNF-α, and homocysteine in blood of the patients were significantly decreased(P<0.01).

Conclusion

Valvular replacement combined with radiofrequency ablation and left atrial appendage closure in the treatment of patients with valvular disease complicated with atrial fibrillation has good effect,and it can improve the cardiac function of patients, decrease the levels of inflammatory cytokines and homocysteine, reduce the incidence of cerebral infarction and bleeding, and improve the life quality of patients.

Key words: valve replacement, radiofrequency ablation, left atrial appendage closure, inflammatory cytokines, homocysteine, stroke

中图分类号: 

  • R542.5