双极射频消融治疗心房纤颤的临床疗效分析

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1、分类号：R654.2学校代码：10661学号：2012357密级：公开硕士学位论文（专业型学位）双极射频消融治疗心房纤颤的临床疗效分析Analysisofbipolarradiofrequencyablationintreatmentofatrialfibrillation姓名：陈枫杰专业：外科学研究方向：心胸外科导师：向道康教授、刘小斌教授培养单位：贵州省人民医院2015年5月目录1论文：双极射频消融治疗心房纤颤的临床疗效分析„„„1中英缩略词对照表„„„„„„„„„„„„„„„„„1中文摘要„„„„„„„„„„„„„„„„„„„„„2英文摘要„„„„„„„„„„„„„„„„„„

2、„„„3前言„„„„„„„„„„„„„„„„„„„„„„„5材料与方法„„„„„„„„„„„„„„„„„„„„6结果„„„„„„„„„„„„„„„„„„„„„„„12讨论„„„„„„„„„„„„„„„„„„„„„„„15结论„„„„„„„„„„„„„„„„„„„„„„„19参考文献„„„„„„„„„„„„„„„„„„„„„202综述：射频消融治疗心房纤颤的临床研究进展„„„„„„„„„„„„„„„„„„„„„„„„243致谢„„„„„„„„„„„„„„„„„„„„„„„334作者简介„„„„„„„„„„„„„„„„„„„„„34基金项目：贵州省优秀科技教育人才省长资金项目（编号20

3、07-64）贵州省优秀科技教育人才省长专项资金项目（黔2005-44）中英文缩略词表缩略词英文全称中文全称AFAtrialfibrillation心房纤颤BRFABipolarradiofrequencyablation双极射频消融SRSinusrhythm窦性心律LADLeftatrialdiameter左房内径MVRMitralvalvereplacement二尖瓣置换NYHANewYorkHeartAssociation纽约心脏病学会LVEFLeftventricularejectionfraction左室射血分数ECGElectrocardiogram心电图AVRAorti

4、cvalvereplacement主动脉瓣置TVRTricuspidvalvereplacement三尖瓣置换LATLeftatrialthrombus左房血栓清除TVPTricuspidvalveplasty三尖瓣成形1双极射频消融治疗心房纤颤的临床疗效分析中文摘要目的：对心内直视下瓣膜置换同期行双极射频消融治疗心房纤颤（Atrialfibrillation，AF）的临床疗效进行总结，并分析术前危险因素与术后转复律之间的关系。方法：回顾性分析2009年11月至2014年4月在贵州省人民医院心外科同一手术治疗组行心内直视下瓣膜置换同期行双极AF射频消融术病例219例，其中男53例，

5、女166例；年龄20岁~74岁，平均（46.80±10.03）岁；术前行心电图及超声心动图了解心律及心功能指标。术中行射频消融路线相同，术后定期复查心电图并口服胺碘酮半年，随访半年以上，行心电图出现窦性P波则表明转律成功，根据心电图结果，将患者分为窦性心律（Sinusrhythm,SR）组与非SR组，应用统计学方法比较两组患者术前及术中相关因素是否具有统计学意义。结果：患者术中体外循环时间83min-243min，平均（124.80±36.04）min；主动脉阻断时间65min-204min，平均（103.86±31.59）min；术中失血量100ml-1500ml，平均（710.

6、00±281.79）ml；术后机械通气时间1.5h-167h，平均（12.47±17.42）h；术后住ICU时间12h-408h，平均（28.59±33.79）h；术后住院时间6天-41天，平均（14.14±5.05）天；围手术期死亡5.48%(12/219)，其中,因术中低心排死亡2例、术后低心排死亡3例、术后恶性心律失常死亡3例、术后多器官功能衰竭死亡3例、术后心脏后壁出血死亡1例。排除围手术期死亡病例，其余207例中，术后二次开胸止血1.45%（3/207）、急性肾衰1.45%（3/207）、切口愈合不良2.90%（6/207）、临时起搏器使用31.88%（67/207）。出

7、院时SR79.00%(173/219)，非SR15.53%(34/219)。出院后随访6~58个月，平均（27.96±15.57）个月，随访率83.57%(173/207)，失访率16.43%(34/207)，随访期间死亡1.73%（3/173），维持SR89.02%（154/173），非SR10.98%(19/173)。安装永久起搏器0.58%（1/173），因术后复发室上性心动过速行导管射频消融0.58%（1/173）。随访期间因不明原因猝死1.73%（3/173