| 吴有华,李楠.环肺静脉隔离联合左心房顶部线性消融术治疗阵发性房颤 65例分析[J].安徽医药,2020,24(12):2449-2452. |
| 环肺静脉隔离联合左心房顶部线性消融术治疗阵发性房颤 65例分析 |
| Analysis of 65 cases of paroxysmal atrial fibrillation treated by circumpulmonary vein isolation combined with linear ablation of the top of the left atrium |
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| DOI：10.3969/j.issn.1009?6469.2020.12.029 |
| 中文关键词: 心房颤动 导管消融术 心房 环肺静脉隔离 心功能 |
| 英文关键词: Atrial fibrillation Catheter ablation Heart atria Pulmonary vein isolation Cardiac function |
| 基金项目: |
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| 中文摘要: |
| 目的探讨环肺静脉隔离(CPVI)联合左心房顶部线性消融(LARA)手术治疗阵发性房颤病人的临床效果。方法选取大连市第三人民医院 2016年 1月至 2018年 12月收治的 130例阵发性房颤病人，采用随机数字表法将病人分为 CPVI组和联合组(CPVI联合 LARA术治疗)各 65例，对比两组病人的手术时间、 X线下曝光时间、射频消融成功率、手术前后两组病人的左房内径、心尖四腔切面勾画的左，房最大面积(LAA)、二尖瓣开放时心房收缩时左房最大容积(LAV)、二尖瓣血流频谱 A峰峰值流速(VA)、舒张晚期心肌组织运动峰速(Va)、左房射血力(LAF)。结果联合组病人的手术时间、 X线下曝光时间和 CPVI组比较差异无统计学意义(P＞0.05)；联合组的射频消融成功率(89.23%)高于 CPVI组(75.38%)(P＜0.05)；术前， CPVI组和联合组的左房内径、 LAA、LAV、VA、Va、LAF测定值差异无统计学意义(P＞0.05)；术后 3个月，两组病人的左房内径、 LAA、LAV较术前均显著降低(P＜0.05)，两组病人的 VA、Va、LAF较术前均显著升高(P＜0.05)；术后 3个月，联合组病人的左房内径(32.18±1.89)mm、LAA(14.20±1.15)cm2、LAV(30.75±2.01)mL低于 CPVI组(33.71±1.90)mm、(15.41±1.32)cm2、(31.84±2.21)mL(P＜0.05)，联合组的 VA(61.81±2.98)cm/s、Va(9.31±0.32)cm/s、LAF(11.41±1.88)kdaynes高于 CPVI组(59.73±3.02)cm/s、Va(8.95±0.38)cm/s、LAF(10.53±1.92)kdaynes(P＜0.05)；联合组的手术并发症率 3.08%与 CPVI组的 6.15%比较，差异无统计学意义(P＞0.05)。结论阵发性房颤病人射频消融治疗采用 CPVI联合 LARA术较单纯 CPVI治疗具有更高的成功率，术后病人心功能的改善效果更好。 |
| 英文摘要: |
| Objective To explore the clinical effect of circumpulmonary vein isolation(CPVI)combined with linear ablation of the top of the left atrium(LARA)surgery in the treatment of patients with paroxysmal atrial fibrillation.Methods A total of 130 pa? tients with paroxysmal atrial fibrillation admitted to Dalian Third People’s Hospital from January 2016 to December 2018 were se?lected.The patients were assigned into the CPVI group and the combined group(CPVI combined with LARA surgery)using a ran? dom number table method，with 65 cases in each group.The operation time，X?ray exposure time，radiofrequency ablation success rate of the two groups of patients were compared，the left atrial diameter of the two groups of patients before and after the operation， and the maximum area of the left atrium(LAA)delineated by the apical four?chamber view，the maximum volume of the left atri? um(LAV)during open atrial contraction，the peak?to?peak velocity of the mitral valve blood flow spectrum A(VA)，the peak ve? locity of myocardial tissue motion in late diastole(Va)，and the left atrial ejection force(LAF).Results There was no significant difference in operation time，X?ray exposure time between the CPVI group and the combined group(P＞0.05).The success rate of radiofrequency ablation in the combined group(89.23%)was higher than that in the CPVI group(75.38%)(P＜0.05).Before op? eration，there was no statistically significant difference in left atrial diameter，LAA，LAV，VA，Va，and LAF between the CPVI group and the combined group(P＞0.05).Three months after the operation，the left atrium diameter，LAA，LAV of the two groups of pa? tients were significantly lower than before operation(P＜0.05)， LAF was significantly higher than before operation(P＜0.05). Three months after the operation，the left atrial diameter(32.18±1.89)mm，LAA(14.20±1.15)cm2 and LAV(30.75±2.01)mL of the combined group were lower than those in the CPVI group(33.71±1.90)mm and(15.41±1.32)cm2(31.84±2.21)mL，the dif? ference was statistically significant(P＜0.05).VA(61.81±2.98)cm/s，Va(9.31±0.32)cm/s，LAF(11.4，1±1.88)kdaynes in the combined group were higher than those in the CPVI group(59.73±3.02)cm/s，Va(8.95±0.38)cm/s，LAF(10.53±1.92)kdaynes，the difference was statistically significant(P＜0.05).There was no statistically significant difference in the surgical complicationrate of 3.08 % in the combined group and 6.15 % in the CPVI group(P＞0.05).Conclusion The use of CPVI combined with LARA in the treatment of paroxysmal atrial fibrillation by radiofrequency ablation has a higher success rate than CPVI alone，and the effect of improving the heart function of patients after surgery is better. |
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