Page 95 - 《南京医科大学学报（自然科学版）》2026年第3期

第46卷第3期 南京医科大学学报（自然科学版）
2026年3月 Journal of Nanjing Medical University（Natural Sciences） ·403 ·

·临床研究·

术前左心室射血分数作为迷宫Ⅳ射频消融联合瓣膜术后房颤

复发独立预测因子的倾向性评分匹配研究

葛 愿 ，蔡岩坡 ，李明辉 ，顾嘉玺 1*
1
2
1
南京医科大学第一附属医院心脏大血管外科，江苏 南京 210029；启东市人民医院胸外科，江苏 南通 226200
1 2

［摘 要］ 目的：探索术前左心室射血分数（left ventricular ejection fraction，LVEF）水平对迷宫Ⅳ射频消融联合瓣膜手术后房
颤（atrial fibrillation，AF）复发的影响。方法：选择2014年1月—2023年12月在南京医科大学第一附属医院心脏大血管外科行
迷宫Ⅳ射频消融联合心脏瓣膜手术患者的临床及随访资料。按照术前 1 周超声心动图所测 LVEF 结果，分为低 LVEF 组
（LVEF<50%）以及正常LVEF组（LVEF≥50%）。采用倾向性评分匹配（propensity score matching，PSM）研究方法，将两组患者进
行1∶2匹配，比较匹配后两组患者术后AF发生率。结果：最终纳入患者513例，匹配前低LVEF组66例，其中男39例，女27例，
年龄（59.7±8.7）岁；正常LVEF组447例，其中男179例，女268例，年龄（59.4±9.5）岁。采用PSM后低LVEF组纳入患者64例，正
常 LVEF 组纳入患者 125 例，其中低 LVEF 组术后 AF 复发率明显高于正常 LVEF 组（log⁃rank，P=0.013），Cox 回归模型显示低
LVEF是迷宫Ⅳ射频消融联合心脏瓣膜手术后AF复发的独立危险因素。结论：较低的术前LVEF可明显增加迷宫Ⅳ射频消融
联合心脏瓣膜手术后AF的复发率。
［关键词］ 左心室射血分数；心房颤动；迷宫Ⅳ手术；倾向性评分匹配
［中图分类号］ R541.7 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）03⁃403⁃10
doi：10.7655/NYDXBNSN250971

Preoperative left ventricular ejection fraction as an independent predictor for atrial

fibrillation recurrence after Maze Ⅳ combined with valve surgery：a propensity score ⁃
matched study
1
1
2
GE Yuan ，CAI Yanpo ，LI Minghui ，GU Jiaxi 1*
1 Department of Cardiothoracic and Vascular Surgery，the First Affiliated Hospital of Nanjing Medical University，
2
Nanjing 210029；Department of Thoracic Surgery，Qidong People’s Hospital，Nantong 226200，China
［Abstract］ Objective：To explore the influence of preoperative left ventricular ejection fraction（LVEF）on the risk of atrial
fibrillation（AF）recurrence after combined Cox Maze Ⅳ and valvular surgery. Methods：We retrospectively reviewed clinical and
follow up data of patients who underwent Cox Maze Ⅳ combined with valvular surgery at the Department of Cardiothoracic and
Vascular Surgery，the First Affiliated Hospital of Nanjing Medical University，between January 2014 and December 2023. Patients
were classified by echocardiographic LVEF measured within one week before surgery into a low LVEF group（LVEF<50%）and a
normal LVEF group（LVEF≥50%）. Propensity score matching（PSM）was performed at a 1∶2 ratio to balance baseline covariates
between groups. Postoperative AF recurrence rates were compared between matched groups. Results：A total of 513 patients were
initially included. Before matching，the low LVEF group comprised 66 patients（39 males，27 females）with a mean age of（59.7±8.7）
years，while the normal LVEF group comprised 447 patients（179 males，268 females）with a mean age of（59.4±9.5）years. After PSM，
64 patients remained in the low LVEF group and 125 in the normal LVEF group. The postoperative AF recurrence rate was
significantly higher in the low LVEF group compared to the normal LVEF group（log⁃rank，P=0.013）. Cox regression analysis identified
low LVEF as an independent risk factor for AF recurrence after Cox⁃Maze Ⅳ combined with valvular surgery. Conclusion：Lower
preoperative LVEF is associated with a higher risk of AF recurrence after combined Cox Maze Ⅳ and valvular surgery.

［基金项目］ 国家自然科学基金（82200340）
∗
通信作者（Corresponding author），E⁃mail：gujiaxi0805@163.com(ORCID：0000⁃0001⁃7732⁃5151)