摘要
背景:前期研究证实,迷宫Ⅲ手术是治疗二尖瓣病变合并持续性或长期持续性心房颤动安全且有效的方法,但老年患者手术耐受性差,有关老年患者行迷宫Ⅲ手术安全性及有效性的相关报道较少。目的:评价迷宫Ⅲ手术治疗老年二尖瓣病变合并持续性或长期持续性房颤患者的安全性和有效性。方法:纳入2013年5月至2017年11月中国人民解放军北部战区总医院(原中国人民解放军沈阳军区总医院)收治的二尖瓣病变合并持续性或长期持续性房颤患者166例,依据WHO发展中国家公民年龄≥60周岁为老年人的定义,分为老年组(年龄≥60岁,n=70)和非老年组(年龄<60岁,n=96),对两组实施迷宫Ⅲ手术,同期行瓣膜置换或瓣膜成形手术。对比两组术中指标、术后安全性指标及术后早期疗效。试验已通过中国人民解放军北部战区总医院(原中国人民解放军沈阳军区总医院)伦理委员会审核,伦审k(2015)33号。结果与结论:①术中指标:两组主动脉阻断时间、体外循环时间、出血量、二尖瓣手术类型比较差异无显著性意义(P>0.05),老年组冠状动脉旁路移植术和生物瓣使用多于非老年组(P<0.05);②术后安全性指标:两组间二次开胸止血、低心排综合征、脑卒中、肝肾功能不全、再次气管插管、主动脉内球囊反搏植入、起搏器应用及早期死亡等不良事件发生率比较差异无显著性意义(P>0.05),ICU停留时间及术后住院时间比较差异无显著性意义(P>0.05);老年组呼吸机使用时间长于非老年组(P<0.05);③术后早期疗效:两组出院时、术后6个月、术后1年的心功能分级均较术前明显改善,但两组间比较差异无显著性意义(P>0.05);两组间出院时、术后6个月、术后1年的窦性心律恢复率比较差异无显著性意义(P>0.05),均在85%以上;④结果表明:迷宫Ⅲ型手术治疗老年二尖瓣病变合并持续性或长期持续性心房颤动是安全的,近期疗效满意。
BACKGROUND:Preliminary studies have shown that the Cox-MazeⅢprocedure is safe and effective method to treat persistent or long-standing persistent atrial fibrillation.As the surgical tolerance of elderly patients is poor,the safety and effectiveness of Cox-MazeⅢfor elderly patients are rarely reported.OBJECTIVE:To evaluate the safety and efficacy of Cox-MazeⅢprocedure in elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation.METHODS:One hundred and sixty-six patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation admitted at General Hospital of Northern Theater Command(General Hospital of Shenyang Military Region of Chinese PLA)from May 2013 to November 2017 were included.According to the World Health Organization definition of the elderly people,they were divided into elder group(≥60 years,n=70)and young group(<60 years,n=96),followed by undergoing Cox-MazeⅢprocedure and valvular replacement or valvuloplasty.The intraoperative indexes,postoperative safety indexes and early-term and efficacy were compared between two groups.The study was approved by the Ethics Committee of General Hospital of Northern Theater Command(General Hospital of Shenyang Military Region of Chinese PLA),approval number:k(2015)33.RESULTS AND CONCLUSION:(1)Intraoperative safety indexes:there was no significant difference in the time of aortic clamping,cardiopulmonary bypass time,blood loss and surgical type between two groups(P>0.05).The elderly group had more patients to conduct the coronary artery bypass grafting and the use of biological valve than the young group(P<0.05).(2)Postoperative safety indexes:the incidence of adverse events such as the re-thoratomy for hemaostsis,low cardiac output syndrome,stroke,hepatic and renal dysfunction,secondary tracheal intubation,intra-aortic balloon pump implantation,temporary pacemaker application and early-term mortality were insignificant differences between two groups(P>0.05).There were no significant differences in the intensive care unit stay time and postoperative hospitalization time(P>0.05)between two groups.The time of ventilator use in the elderly group was significantly longer than that in the young group(P<0.05).(3)Postoperative efficacy:the New York Heart Association classes at discharge and postoperative 6 and 12 months were significantly improved in all patients compared with the baseline,and there was no significant difference between two groups(P>0.05).The rate to achieve sinus rhythm at discharge and postoperative 6 and 12 months showed no significant difference between two groups(P>0.05),which reached above 85%.(4)These results indicate that Cox-Maze III procedure possesses safety for elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation,and the short-term efficacy is satisfactory.
作者
韩冰
王辉山
韩劲松
尹宗涛
谢赛旗
Han Bing;Wang Huishan;Han Jinsong;Yin Zongtao;Xie Saiqi(Graduate School of Dalian Medical University,Dalian 116044,Liaoning Province,China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,Liaoning Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第22期3562-3569,共8页
Chinese Journal of Tissue Engineering Research
基金
2017年辽宁省自然基金计划重点项目(20170540977),项目负责人:韩劲松~~
关键词
迷宫手术
老年患者
心脏瓣膜病
心房颤动
长期持续性心房颤动
人工瓣膜
二尖瓣病变
Cox-Maze procedure
elderly patients
heart valve disease
atrial fibrillation
long-standing persistent atrial fibrillation
artificial valve
mitral valve disease
