Abstract： Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation（AF） and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was（56.1±47.1） months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was（43.8±25.6） months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass（CPB）time, aortic cross-clamping（ACC）time, mechanical ventilation time, intensive care unit（ICU） length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different （P＞0.05）. The CPB time and ACC time between the two groups were not statistically different （P＞ 0.05）. The postoperative hospital stay of ablation group was significantly longer than that of control group （15.8±6.1 d vs. 12.9±3.1d，P=0.001）. No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group（59.6%±9.2% vs. 55.5%±5.4%，P＜ 0.01）. The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87.5%, 87.1% and 82.4% respectively, 3.3%, 2.2%, 0.0%, and 0.0% in control group respectively, which was statistically different between the two groups（P＜ 0.05）. Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.
目的:本文回顾性分析总结32例心脏瓣膜置换术同期改良迷宫术患者的麻醉处理。方法:32例瓣膜病合并心房颤动患者,ASA分级Ⅱ-Ⅳ级,心功能ⅢⅣ级,采用以芬太尼为主的全身麻醉,术中以硫酸镁和艾司洛尔调控应激反应,复温后多联合使用多巴胺或(和)多巴酚丁胺5～10μg/kg·min、硝酸甘油或硝普钠0. 5～5μg/kg·min等血管活性药物以达到扩张血管增强心肌收缩力、降低心脏负荷、维持循环稳定的目的。停机后预防性安置心外膜起搏导线,使用异丙肾上腺素后心率仍慢者,及时运用临时起搏,保证有效的心肌收缩和稳定的心率。结果:射频消融时间为32±5分钟,主动脉阻断时间89±12分钟; 体外循环时间109±20分钟。心脏自动复跳29例, 电除颤复跳3例, 32例患者术后均为窦性心律。5例患者使用临时起搏器。结论:完善的术前准备和围术期重视心肺功能的支持治疗, 合理调控应激反应等措施是手术成功的重要基础。