68例射频消融术对血栓前状态的影响及阿司匹林的作用  

Influence of radiofequency catheter ablation and effect of aspirin on prethrom botic state

作　　者：彭永权[1] 周锡平[1] 

机构地区：[1]四川省泸州市泸州医学院附属医院心内科,四川泸州646001

出　　处：《中国现代医学杂志》2007年第24期3028-3030,3033,共4页China Journal of Modern Medicine

摘　　要：目的探计射频导管消融术(RFCA)对血栓前状态的影响,评价阿司匹林(Asp)的干预作用。方法选择68例行RFCA的阵发性室上性心动过速患者将其随机分成两组:Asp组(n=36):术前3d口服Asp;对照组(n=32):术前不用药。分别于术前(To)、电生理检查(EPS)后(T1)、射频放电后即刻(T2)、术后24h(T3)测定血浆血管性假血友病因子(VWF)、内皮素(ET)、血小板a颗粒膜糖蛋白140(GMP-140)和D二聚集(DD),比较两组内不同时间点各项指标的变化及两组间的差异。并作RFCA的程序变量与血栓前状态的分子标志物变化的相关性分析。结果两组患者VWF和ET在不同时间点较术前差异无显著性(P>0.05);对照组GMP-140和DD在T1时刻即有显著升高(P<0.05),T2时刻进一步升高达峰值,T3较T0有所下降,但仍明显高于术前(P>0.05);Asp组GMP-140在T1、T2、T3时刻与T0时刻比较无明显升高(P>0.05),而DD仍有显著升高(P<0.05或P<0.01),但与对照组同一时间点比较升高的幅度明显降低(P<0.05);GMP-140和DD升高的幅度与手术持续时间呈正相关(r=0.48,r=0.41,P<0.05)。结论尽管术中应用肝素,RFCA仍可导致血栓前状态。RFCA致血栓前状态与手术持续时间呈正相关。Asp可减轻RFCA引起的血栓前状态。[Objective] To detect the influence of radiofequency catheter ablation （RFCA）, and to evaluate the effect of pretreatment with aspirin on prethrombotic state. [Methods] Sixty-eight patients with superaventrieular taehyeardia undergoing RFCA were randomized to control group with out aspirin （n =32） before RFCA and pretreatment group with aspirin （n =36） for 3 days prior to RFCA. VWF, ET, GMP-140 and D-dimer levels of plasma were measured at four differrent time points before RFCA（T0）, after the electrophysiologie studys（EPS）（T1）, immediately after the last RFCA（T2） and at 24 hours after RFCA（T3）, The changes with in groups at differrent time points and the differenees between groups at same time points were compared. [Results] There were no remarkable differrenee at different time points in both groups for the levels of plasma VWF and ET before RFCA （P 〉0.05）. In eontrol group, GMP-140and DD levels of plasma increased significantly （P 〈0.05, P 〈0.1301） after EPS, further rise to peak values immediately after RFCA （P 〈0.0001）, and slightly decreased at 24 h after RFCA, whieh were still highter than the values before RFCA （P 〈0.05）, （P 〈0.01）. In Asp group, there were no remarkable elevation in the levels of plasma GMP-140 at different time points, compared with the values before RFCA （P 〉0.05）. However, DD still elevated （P 〈0.05, P 〈0.01）, compared with the values before RFCA, which were much lower than the values at same time points in control group （P 〈0.05）. Procedure duration was the only variable that correlated with the relative increase in GMP-140 and DD （r =0.48, r =0.41, P 〈0.05）. [Conclusion] Although intravenous heparin is ad ministered during the operation, the prethromboric state can be introducted by RFCA. Prethrom boric state caused by RFCA is related to procedure duration pretreatment with aspirin can prevent prethrombotic state.

关 键 词：导管消融 射频电流 血栓前状态 阿司匹林 

分 类 号：R654.29[医药卫生—外科学]