摘要
目的探讨二尖瓣置换加迷宫手术（ＭＶＲ－ＭＰ）对二尖瓣病变伴心房颤动（房颤）患者的心律转复作用及对心电活动和心功能的影响。方法应用心电图、动态心电图、运动负荷心电图及超声心动图观察２８例ＭＶＲ－ＭＰ患者手术前后心电活动、心功能及运动耐量变化，并与９８例单纯二尖瓣置换术（ＭＶＲ）患者的相应指标比较。术前两组均为二尖瓣病变伴长期房颤患者。结果在随访中ＭＶＲ－ＭＰ组和ＭＶＲ组恢复并维持窦性心律分别为９２．９％和２．０％（Ｐ＜０．０１）；ＭＶＲ－ＭＰ组心律转复后Ｐ波矮小、时限较长，动态及运动心电图未见严重心律失常；两组手术后心功能改善级别分别为２．３７±０．６９和１．４３±０．６７（Ｐ＜０．０１），所能完成的做功量分别为１０．６７±１．５６和５．２８±０．５９ＭＥＴｓ（Ｐ＜０．０１），左室射血分数分别为（６５．０±９．２）％及（５１．４±１０．４）％（Ｐ＜０．０１）。结论ＭＶＲ－ＭＰ可使二尖瓣病变伴长期房颤患者恢复窦性心律，可显著提高运动耐量、改善心功能。
Objectives This study was designed to evaluate the efficacy in return and maintenance of sinus rhythm and the improvement of cardiac function by mitral valve replacement plus Cox maze procedure (MVRMP) in patients with rheumatic mitral disease and atrial fibrillation.HZMethods Twentyeight patients underwent MVRMP and 98 patients treated with mitral valve replacement (MVR) along were followed up 8 months after surgery by evaluating electrocardiogram (ECG),Holter monitoring,treadmill testing and two dimensional echocardiography.All patients had chronic mitral valve disease with longterm atrial fibrillation preoperatively.Sex,age,cardiac function,duration of atrial fibrillation and size of left atrium were matched between two groups. Results The followup showed that the presence of sinus rhythm was 929% in MVRMP group and 20% in MVR group (P<001),the returned P wave was tiny and wide,there were no severe arrhythmia found during Holter monitoring and treadmill testing;the cardiac function improved by the grade (NYHA) of 237069 in MVPMP group and 143067 in MVR group (P<001),the obtained maximal work during treadmill testing was 1067156 METs in MVRMP group and 528059 METs in MVR group(P<001),and echocardiographyderived left ventricular ejection fraction averaged (65092)% and (514104)% in the two groups,respectively (P<001).Conclusion MVRMP can effectively restore sinus rhythm and signifi cantly improve exercise tolerance and cardiac function in patients with rheumatic mitral disease and atrial fibrillation.
出处
《中华心律失常学杂志》
1999年第2期123-125,共3页
Chinese Journal of Cardiac Arrhythmias
