河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (1): 23-26.doi: 10.3969/j.issn.1007-3205.2021.01.005

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CoxⅢ型迷宫手术在心脏瓣膜病合并心房颤动中的应用

  

  1. 1.河北医科大学第一医院心外科，河北 石家庄 050031；2.中国人民解放军北部战区总医院心外科，辽宁 沈阳 110016
  • 出版日期:2021-01-25 发布日期:2021-02-04
  • 作者简介:吕瑛（1979-），女，山西阳泉人，河北医科大学第一医院副主任医师，医学硕士，从事心血管外科疾病诊治研究。
  • 基金资助:
    河北省医学适用技术跟踪项目（GL201644）

Application of Cox-maze  Ⅲ procedure in patients with atrial fibrillation in valvular heart disease

  1. 1.Department of Cardiac Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 
    050031, China; 2.Department of Cardiac Surgery, General Hospital of Northern 
    Theater Command, Shenyang 110016, China
  • Online:2021-01-25 Published:2021-02-04

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摘要： 目的  探讨CoxⅢ型迷宫手术治疗心脏瓣膜病合并心房颤动的临床效果。
方法  回顾性分析心脏瓣膜病合并心房颤动行CoxⅢ型迷宫手术患者12例的临床资料。所有患者均在全身麻醉下经胸骨正中切口行CoxⅢ型迷宫手术和心脏瓣膜置换手术，通过手术前后心脏超声心动图指标观察心功能情况，并总结其临床经验。
结果   所有患者顺利完成心脏瓣膜手术及迷宫手术，无围手术期死亡，无Ⅲ度房室传导阻滞、冠状动脉损伤及脑血管意外情况。体外循环时间143~201 min，平均（174.43±15.46）min；主动脉阻断时间81~96 min，平均（88.71±3.54）min，呼吸机应用时间18~47 h。术毕复跳时均无心房颤动。术后发生低心排综合征1例，经强心利尿，改善心功能等治疗后好转；低氧血症1例，经控制感染，雾化排痰，加强体疗后恢复。住院期间应用心脏起搏器起搏4例，出现心房颤动2例，心房扑动1例，其中电复律1例，其余给予补充血容量及应用抗心律失常药物等治疗，术后出院时恢复窦性心律11例（91.67%）。所有患者术后定期随访3个月~2年，心功能明显改善。随时间延长，左心房内径、左心室舒张末期内径、左心室收缩末期内径均逐渐减小，左心室射血分数逐渐增大，差异有统计学意义（P＜0.01）。
结论   CoxⅢ型迷宫手术治疗心脏瓣膜病合并心房颤动的临床效果肯定，精准把握手术指征和严格掌握外科手术操作技术，有助于提高手术疗效。


关键词: 心脏瓣膜疾病, 心房颤动, CoxⅢ型迷宫手术

Abstract: Objective  To evaluate the clinical effect of Cox-maze Ⅲprocedure in the treatment of cardiac valvular disease with atrial fibrillation. 
Methods  The clinical data of 12 patients with cardiac valvular disease complicated with atrial fibrillation undergoing Cox-maze Ⅲ  procedure were retrospectively analyzed. All patients underwent Cox-maze Ⅲprocedure and cardiac valve replacement through median sternal incision under general anesthesia. Cardiac function was observed by echocardiography before and after surgery, and clinical experience was summarized. 
Results  The whole group successfully completed heart valve surgery and maze surgery, without perioperative death, no third-degree atrioventricular block, coronary artery injury and cerebrovascular accident. The extracorporeal circulation time was 143-201 min, with an average(174.43±15.46) min. Aorta occlusion lasted 81-96 min(88.71±3.54) min on average, and ventilator application lasted 18-47 h. There was no atrial fibrillation heart rate when the surgery was repeated. Postoperative perioperative complications: 1 case of low cardiac output syndrome was improved after treatment of strong cardiac diuretic and improved cardiac function. One case of hypoxemia, after infection control, atomization of sputum drainage, strengthening the recovery after body therapy. During the period of hospitalization, 4 patients were treated with pacemaker pacing, 2 with atrial fibrillation, 1 with atrial rhythm, 1 with electro-cardioversion, the rest were treated with supplementary blood volume and antiarrhythmic drugs, and 11 cases (91.67%) recovered sinus rhythm after discharge. All patients were followed up regularly for 3 months to 2 years after surgery, and their cardiac function was significantly improved. With the extension of time, the left atrial diameter(LAD), left ventricular end diastolic dimension(LVEDD), and left ventricular end-systolic diameter(LVESD) were gradually reduced, left ventricular ejection fraction（LVEF） increased gradually, the difference was statistically significant(P＜0.01). 
Conclusion  The clinical effect of Cox-maze Ⅲ procedure in the treatment of valvular heart disease combined with atrial fibrillation is positive, accurate grasp of surgical indications and strict grasp of surgical operation technology is conducive to improve the surgical effect.


Key words: heart valve diseases, atrial fibrillation, Cox-maze Ⅲ procedure

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