抗血小板制剂对射频消融术前后vWF、血小板和凝血纤溶活性的影响  

Effect of antiplatelet therapy on the hemostatic system in patients with radiofrequency catheter ablation

作　　者：谢芳元[1] 张清[2] 刘兵[2] 王海昌[2] 张荣庆[2] 程何祥[2] 

机构地区：[1]西安市第四医院,陕西西安710004 [2]第四军医大学西京医院心内科,陕西西安710032

出　　处：《现代生物医学进展》2008年第10期1890-1896,共7页Progress in Modern Biomedicine

摘　　要：目的:探讨消融技术后血栓栓塞的机制和预防的方法,为临床提供血栓栓塞并发症的防治方法。方法:在我科行射频消融术的室上速患者158名,年龄15～61岁,其中右侧旁道12例,双径路62例,左侧旁道84例。随机分为五组,组Ⅰ(n=31)术前未服抗血小板制剂,术后立即服用阿斯匹林0.3g,1/日;组Ⅱ(n=32)术前3天始服用阿斯匹林0.3g,1/日;组Ⅲ(n=30)术前3天始服用氯吡格雷75mg1/日;组Ⅳ(n=32)术前3天服用阿斯匹林0.3g+氯吡格雷75mg1/日;组V(n=33)术前3天始服用阿斯匹林0.3g,1/日,术后皮下注射速避凝0.4ml1/日。分别于入院后、电生理检查前即成功放置鞘管后、消融前即静推肝素前、消融后即刻、消融后24h采血。测定血浆血小板α颗粒膜蛋白(GMP-140)水平、D-二聚体、血管性假血友病因子(vWF)。结果:①组ⅠGMP-140水平自穿刺后即开始上升,射频消融术后24小时仍处于较高水平,血管穿刺后电生理检查前明显升高为30.41±5.67ng/m(lP<0.05),而射频消融术后升高为60.4±12.79ng/m(lP<0.05),但组Ⅱ、Ⅲ、Ⅳ、V尤其是组ⅣGMP-140水平始终处于相对较低的水平(P<0.05)。②组ⅠD-二聚体水平自穿刺后即开始上升,射频消融术后24小时仍处于较高水平,血管穿刺后电生理检查前明显升高为0.58±0.22mg/L(P<0.05),而射频消融术后升高为1.50±0.56mg/L(P<0.05)。组Ⅱ、Ⅲ、Ⅳ、V尤其是组ⅣD-二聚体水平与组Ⅰ相比始终处于较低水平(P<0.05)。③血浆vWF的水平:各组vWF水平自血管穿刺结束后即明显升高(P<0.05),射频消融术后组Ⅰ、Ⅲ升高明显,而组Ⅱ、Ⅳ、VvWF水平只有轻度升高(P<0.05),各组vWF水平在术后24小时仍维持相对较高的水平。④血浆GMP-140、D-二聚体、vWF在射频消融前后的改变与累及放电量、放电时间、放电次数、消融时间及肌钙蛋白I等无关(P<0.05)。结论:射频消融对内皮细胞有损伤作用,可导致GMP-140、D-二聚体的明显升高呈血栓前Objective： To study the mechanism and preventive measure of thromboembolic complication of RF ablation so as to provided available methods for clinical application. Methods： 158 hospitalized patients （male 81,female 77 ） from September, 2001 to July, 2002 were enrolled in our study. These patients under going RF ablation for supraventricular tachycardia （n=158 ） who were randomly divided into five groups. No patients in graup I （n=31 ） was undergoing antiplatelet therapy before RFCA, but these patients immediately took aspirin after RFCA. Two groups were received pretreatment with either aspirin 0.3 g daily （n=32 group Ⅱ ） or clopidogrel 75mg daily （n=30 groupⅢ）for3 days before the procedure, while all group Ⅳ （n=32）patients received similar doses of both aspirin and clopidogrel. The group Ⅴ were received pretreatment with aspirin 0.3 g daily or 3 days before the procedure and low molecular weight heparin for 7 days after RFCA. The first sample （baseline） was drawn from the antecubital vein at the initial stage of admission. The second sample （pre-EPS） was drawn after femoral and internal jugular venous sheath insertions. Blood was drawn before （pre-RF）, at the end of （post-RF）, and 24 hours after the procedure. Specimens were usilized for the analysis of plasma GMP-140？ D-dimer and vWF. Results： All the time, the concentrations of GMP-140 in group Ⅰ were kept on a higher level after sheath insertions. At the pre-EPS and post-RF points, the concentrations in group Ⅰ were 30.41：1：5.67 and 60.40± 12.79 ng/ml per patient （P〈0.05）, respectively. But the concentrations were kept on a lower level in groupⅡ,Ⅲ, especially IV compared with group Ⅰ except baseline point （P〈0. 05）. The concentrations of D-dimer in group Ⅰ were always kept on a higher level after sheath insertions. At the pre-EPS and post-RF points, the concentrations in group I were 0.58± 0.22mg/L？1.50±0.56mg/L （P〈0.05） separately. But the concentrations were kept

关 键 词：射频电流 GMP-140 D-二聚体 VWF 阿斯匹林 氯吡格雷 

分 类 号：R541.7[医药卫生—心血管疾病] R543.31[医药卫生—内科学]