瓣膜置换同期双极射频术后呼吸功能变化研究 - 第三军医大学学报.doc

瓣膜置换同期双极射频消融术后呼吸功能变化研究 李 建，陈 林，肖颖彬，陈柏成，马瑞彦，郝 嘉，程 伟 （400037重庆，第三军医大学新桥医院全军心血管外科研究所 [摘要] 目的 探讨瓣膜置换术同期双极射频消融术后呼吸机支持时间及术后早期恢复情况。方法 回顾性分析2011年瓣膜病伴慢性心房颤动，病史超过6个月，共160例，根据手术方式分为3组，消融组(MVR+COX)：行人工二尖瓣置换同期双极射频消融术75例；二尖瓣置换组(MVR)：单纯行二尖瓣置换术42例；双瓣置换组（DVR）：行人工主动脉瓣及二尖瓣置换术43例。比较3组术后呼吸机支持时间、动脉血气氧分压（PaO2）、动脉血气氧分压/给氧浓度（PaO2/FiO2）、术后引流量及术后第1天、第7天胸片结果。用年龄、体质量、体外循环时间、主动脉阻断时间、术前PaO2 及手术方式与术后呼吸机支持时间行Logistic回归分析。结果 呼吸机支持时间、术后引流量消融组均比MVR组DVR组多；术后PaO2及PaO2/FiO2较其他组偏低，P0.05；术后第1天胸片提示肺部感染比例稍高，但第7天胸片检查结果无明显差异；Logistic回归分析显示，手术方式与术后呼吸机支持时间明显相关。结论 瓣膜置换术同期双极射频消融较单纯瓣膜置换术术后早期呼吸功能恢复稍慢，可能与肺损伤有关。 [关键词] 心房颤动；双极射频消融术；瓣膜置换术；呼吸功能；急性肺损伤。 [中图法分类号] R6 ［文献标识码］ A Research of Respiratory Function After Mitral Valve Replacement Concomitant With Bipolar Radiofrequency Ablation Li Jian1, Chen Lin 2, Xiao Yingbin 3, Chen Baicheng, Ma Ruiyan, Hao Jia, Cheng Wei(Institute of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China) [Abstract] Objective To study the ventilator support time and the physical condition after the valve replacement surgery concomitant with bipolar radiofrequency ablation. Methods Divided 160 patients, who suffered from rheumatic heart disease and chronic atrial fibrillation over 6 months, into 3 groups. Group MVR + COX: 75 cases underwent the mitral valve replacement concomitant with bipolar radiofrequency ablation; Group MVR: 42 cases underwent mitral valve replacement; Group DVR: 43 cases underwent aortic and mitral valve replacement. Observe the ventilator support time, partial pressure of oxygen (PaO2), PaO2/FiO2 and postoperative drainage after surgery, and then the chest radiograph in the first and the seventh day after surgery; Collect ages, weights, duration of on pump time, aorta cross clamping time and preoperative PaO2. Results Compared with group MVR and DVR, ventilator support time of group MVR+COX is longer and postoperative drainage is more, and the postoperative PaO2 or PaO2/FiO2 is l