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血栓塞栓症予防法としての心房細動へのmaze手術の意義(術前後の血液凝固線溶系と活性化血小板接着分子測定による検討)

房颤迷宫手术预防血栓栓塞的意义（术前术后凝血纤溶系统检查及活化血小板粘附分子测定）

基本信息

批准号：
09771000
负责人：
鎌田潤也
金额：
$ 0.96万
依托单位：
Iwate Medical University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Encouragement of Young Scientists (A)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1998
项目状态：
已结题

项目摘要

1. 慢性心房細動症例104例に対し,基礎心疾患手術にMaze手術を併せて行った.病院死亡は4例であったが,いずれの死因もMaze手術との因果関係はなく,また術後出血のための再開胸を2例に要した以外,重篤な合併症は認めていない.2. 手術生存100例の遠隔期(平均5年)における基本調律の内訳は,洞調律68%,心房細動24%,洞機能不全8%と,昨年度の報告より洞調律維持率が減少していた.3. Maze手術後に回復した洞調律例で,ホルター心電図により心拍変動を検討すると,術後早期では口内変動が消失していたが約1年後には改善傾向を示し,さらに約2年後には有意に改善をみた.症候限界性の運動負荷によっても,術後早期には心拍応答の著しい低下をきたすが経時的に改善傾向を示した.4. 心エコー図上,調律回復後には多くの症例で心房収縮能が観察され,さらに術後経時的に改善傾向を示した.5. Maze手術前後の血液凝固系の推移の検討で、手術後早期にはD-ダイマー,アンチトロンビンIII複合体が増加傾向にあるものの,約1年後には減少傾向を示し,さらに約2年後には有意に減少をみた,また,活性化血小板接着分子P-Selectinは,手術前後に有意な変化を示さなかった.6. 生活の質(QOL)に関するアンケート調査で,約1年後には向上する傾向を示し,さらに約2年後には有意に向上していた.7. 今年度までの遠隔期の血栓塞栓症は,洞調律群で1例(1.5%),心房細動群で2例(8,3%)であった.しかしながら,心房細動群の2例では,抗凝固療法が不十分であった可能性があり,人工弁関連の合併症と思われた.引き続き,長期の遠隔成績の追跡調査を行う必要がある.

1. One hundred and four patients with chronic atrial movement were diagnosed as having chronic atrial movement, and the patients with primary heart disease were treated with Maze. There were 4 cases of death in the hospital, the cause of death, and the cause of death. 2. In 100 cases of manual survival, the average interval was 5 years. The basic rhythm was 68%, atrial movement 24%, and the mechanical capacity was 8%. It was reported that the maintenance rate of hole law was significantly lower than that in the previous year. 3. After the Maze handset, you will be able to change the laws and regulations, and the ECG will make you feel better. After that, the movement in your mouth will disappear. After about 1 year, you will be able to improve it. After about 2 years, you will be interested in making improvements. The symptoms of borderline exercise are severe, and early after that, the heart beats to respond to the improvement of the symptoms during the onset of depression. 4. In the case of hyperthyroidism after cardiac rhythm, the atrium can be detected, and the improvement after cardiopulmonary bypass is indicated. 5. Before and after Maze surgery, the blood coagulation system was delayed, D-clotting was detected in the early stage after surgery, and the III complex was added in the early stage after the operation. About 1 year later, it was shown that there was less blood clotting, and after about 2 years, the activated platelets were activated to molecular P-Selectin. 6. After a year or so, I would like to show you that I am interested in going up and going up. 7. After about a year, QOL will show me that I am going up. This year, there were 1 case of thromboembolism (1.5%) and 2 cases of atrial movement (80.3%). There were 2 cases of atrial exercise, anticoagulant therapy was not very effective, the possibility of anticoagulant therapy was not very high, and artificial anticoagulant therapy was found in 2 cases. After a long period of time, it is necessary to keep up with each other for a long time.