目的 探讨姑息性右室-肺动脉连接术在重症紫绀型先天性心脏病治疗中的临床应用。 方法 回顾性分析郑州市第七人民医院心脏外科 2011 年 1 月至 2015 年 1 月期间所有行姑息性右室-肺动脉连接术治疗的重症紫绀型先天性心脏病患者 25 例的临床资料，其中男 17 例、女 8 例，年龄 31（5～108）个月，体重 3.5～37.2（12.82±6.73）kg。 结果 25 例姑息性右室-肺动脉连接术后早期死亡 2 例（术后 30 d 内），早期死亡率 8.0%（2/25）。患者术后动脉血氧饱和度与术前差异有统计学意义（62.43%±7.83%vs. 81.62%±6.25%，P<0.05）。术后随访 6 个月至 3 年（每 3 个月复查一次超声心动图），23 例患者 McGoon 比值（1.05±0.14vs. 1.61±0.18，P<0.05）和 Nakata 指数[（112.37±14.38）mm2/m2 vs. （165.74±22.62） mm2/m2，P<0.05]均明显上升，且差异有统计学意义。17 例患者行二期根治手术治疗。 结论 姑息性右室-肺动脉连接术能够有效促进重症紫绀型先天性心脏病患者的自身肺血管床发育，为行二期根治术创造条件。
ObjectiveTo investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF).MethodsWe retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared.ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05).ConclusionMaze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.