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目的评价心内直视下同期改良冲洗式双极射频消融术治疗心脏瓣膜病并心房颤动(AF)的有效性及安全性。方法选取2013年10月—2015年4月南京医科大学附属淮安第一医院收治的心脏瓣膜病并AF患者64例,采用随机数字表法分为对照组和观察组,每组32例。对照组患者行单极射频消融术,观察组患者行心内直视下同期改良冲洗式双极射频消融术;术后随访3~12个月。比较两组患者手术情况,术后1 d、3个月、6个月、12个月窦性心律维持情况,手术前后左心室射血分数(LVEF)及左心房前后径,并发症发生情况。结果两组患者消融时间、体外循环时间、主动脉阻断时间、住院时间比较,差异无统计学意义(P>0.05)。两组患者术后1 d、3个月窦性心律维持率比较,差异无统计学意义(P>0.05);观察组患者术后6、12个月窦性心律维持率高于对照组(P<0.05)。两组患者手术前后LVEF、左心房前后径比较,差异无统计学意义(P>0.05);两组患者术后LVEF与术前比较,差异均无统计学意义(P>0.05),而两组患者术后左心房前后径均短于术前(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论心内直视下同期改良冲洗式双极射频消融治疗心脏瓣膜病并持续性AF安全有效,可有效缩短左心房前后径,维持术后窦性心律。
Objective To evaluate the efficacy and safety of modified flushing bipolar radiofrequency catheter ablation in the treatment of heart valve disease and atrial fibrillation (AF) under open heart surgery. Methods Sixty-four patients with valvular heart disease and AF who were admitted to Huaian First Affiliated Hospital of Nanjing Medical University from October 2013 to April 2015 were randomly divided into control group and observation group with 32 cases in each group. Patients in the control group underwent unipolar radiofrequency catheter ablation. Patients in the observation group underwent open-heart bipolar radiofrequency ablation undergoing open heart surgery in the same period. The patients were followed up for 3 to 12 months. The operative conditions, the maintenance of sinus rhythm at 1, 3, 6 and 12 months after operation, the left ventricular ejection fraction (LVEF) and the anteroposterior diameter of the left atrium before and after surgery were compared between the two groups. Results There was no significant difference in ablation time, cardiopulmonary bypass time, aortic block time and hospital stay between the two groups (P> 0.05). There was no significant difference in the maintenance rate of sinus rhythm between the two groups at 1 and 3 months after operation (P> 0.05). The maintenance rate of sinus rhythm at 6 and 12 months after operation in the observation group was higher than that in the control group (P <0.05). There was no significant difference in LVEF and anteroposterior diameter of left atrium between the two groups before and after surgery (P> 0.05). There was no significant difference between the two groups in the postoperative LVEF and before operation (P> 0.05) The anteroposterior diameter of the left atrium was shorter than that before operation (P <0.05). There was no significant difference in complication rates between the two groups (P> 0.05). Conclusions The improved bipolar radiofrequency catheter ablation and valvuloplasty under continuous open heart surgery are safe and effective. It can shorten the anteroposterior diameter of the left atrium and maintain the sinus rhythm.