【作者】 张超；

【导师】 汤宝鹏；

【作者基本信息】 新疆医科大学 ， 内科学， 2007， 硕士

【摘要】 目的:探讨风湿性心脏病二尖瓣狭窄合并心房颤动患者,行经皮球囊二尖瓣成形术(Percutaneous Balloon Mitral Valvuloplasty,PBMV)或二尖瓣替换术后影响房颤自然转复的因素。方法:将我院1994年1月至2006年6月12年间行PBMV或二尖瓣置换术的402例风湿性二尖瓣狭窄合并房颤的患者进行回顾性研究(其中行PBMV者65例,行二尖瓣置换术者337例)。根据患者的病史、超声心动图、临床资料和随访结果对手术后房颤自然转复为窦性心律的比例及影响因素进行分析。结果:经皮二尖瓣球囊成形术后65例患者,术后2周内转复为窦性心律者15例(23%),上述患者随访3～6个月后仍维持窦性心律者10例(15%);二尖瓣置换术后337例患者,转复为窦性心律者98例(29%),上述患者随访3～6个月后仍维持窦性心律者47例(14%)。经皮球囊二尖瓣成形术和二尖瓣置换术后影响房颤转归的独立危险因素为:年龄(P＜0.01,OR 1.24)、术前房颤持续时间(P＜0.01,OR 1.18)、术前左心房内径(P＜0.01,OR 1.28)和术后左心房内径(P＜0.01,OR 1.72)。结论:无论经皮球囊二尖瓣成形术还是二尖瓣置换术仅能使少部分风湿性二尖瓣狭窄合并房颤的患者恢复窦性心律。年龄、术前房颤持续时间、手术前后左房内径是影响术后房颤自然转复的独立危险因素。更多还原

【Abstract】 Objective:To evaluate the effective factors of natural conversion of atrial fibrillation(AF)by percutaneous balloon mitral valvuloplasty(PBMV)or mitral valve replacement in patients with rheumatic mitral stenosis.Methods:From January 1994 to June 2006,65.consecutive patients with rheumatic mitral stenosis and atrial fibrillation who underwent PBMV and 337 patients who underwent mitral valve replacement were analysed retrospectively.In this study,clinical histories,echocardiograms,clinical datas, and follow-up data were viewed to evaluate the rate and predict the natural restoration of sinus rhythm.Results:15 patients(23%)of 65 patients regained sinus rhythm after PBMV within two weeks,during the follow-up period(3-6 months)only 10 patients(15%) maintained sinus rhythm;98 patients(29%)of 337 patients regained sinus rhythm after mitral valve replacement within two weeks,during the follow-up period(3-6 months) only 47 patients(14%)maintained sinus rhythm.Age(P＜0.01,OR 1.24),duration of AF (P＜0.01,OR 1.18),left atrail size before PBMV or mitral valve replacement(P＜0.01,OR 1.28)and left atrail size after PBMV or mitral valve replacement(P＜0.01,OR1.72)were independent dangerous factors of affecting AF conversion.Conclusion:AF can restore sinus rhythm in some patients with rheumatic mitral stenosis after PBMV or mitral valve replacement.Age,duration of AF,and left atrail size are dependent dangerous factors to influence natural convertion of AF.更多还原