射频消融术对凝血功能的影响及肝素的干预作用  

The Impact of Radiofrequency Catheter Ablation on Coagulation Function and the Preventive Effect of Heparin in Related Patients

作　　者：吴再涛[1] 李玲[2] 单其俊[3] 

机构地区：[1]第二军医大学长征医院南京分院心内科,江苏省南京市210015 [2]第二军医大学长征医院南京分院骨科,江苏省南京市210015 [3]南京医科大学第一附属医院心脏科

出　　处：《中国循环杂志》2013年第1期37-39,共3页Chinese Circulation Journal

摘　　要：目的:了解射频消融(Radiofrequency catheter ablation,RFCA)术对患者凝血功能的影响及肝素的干预作用。方法:连续入选接受RFCA治疗的快速性心律失常患者31例,根据手术不同路径分为经右心导管组16例,经左心导管组15例。经左心导管组术中经血管鞘注射肝素钠50 U/kg,经右心导管组未注射肝素钠。分别于术前及术后20 h抽取静脉血测定血浆D-二聚体水平,采用自身对照的方法进行统计学处理,了解手术前后患者血浆D-二聚体水平的变化及肝素的干预作用。结果:①RFCA术后患者血浆D-二聚体水平明显升高。②经左心导管组术中虽应用了肝素钠,但其术后血浆D-二聚体水平仍会升高。③经右心导管组手术也会引起血浆D-二聚体升高,其升高的程度与经左心导管组手术术中应用肝素钠者无显著差异。④血浆D-二聚体升高的程度与放电时间、累计放电能量、消融温度及手术时间无相关性。结论:①RFCA术可引起机体呈高凝状态和继发性纤溶亢进,血凝状态改变,有血栓形成风险。②肝素钠还不足以对RFCA术所致的血凝状态改变产生保护作用。③经右心导管行RFCA的患者也应考虑给予适当的抗凝及抗血小板活化药物,以减少RFCA术后潜在的血栓危险。Objective：To explore the impact of radiofrequency catheter ablation（RFCA） on coagulation function and the preventive effect of heparin in related patients. Methods：A total of 31 consecutive patients with tachyarrhythmia who received RFCA treatment were recruited and divided into 2 groups according to their surgical pathways. Via right heart catheterization （ Right group）, n = 16, and via left heart catheter- ization （Left group） ,n = 15. The patients in Left group received heparin 50 U/kg via vascular sheath injection in surgery, while Right group had no heparin. Blood samples were collected before surgery and 20 hours after surgery to examine plasma D-dimer levels and to assess the preventive function of heparin in both groups. Results ： ①D-dimer level was significantly increased after RFCA in both groups. ②D-dimer level in Left group also increased even with heparin injection. ③The increased D-dimer level in Right group was similar to that in Left group. ④ The elevated D-di- rect levels were not related to the discharge time, cumulative discharge energy, melting temperature and operation time. Conclusion ： ① RFCA could cause the patients＇ hypercoagulability and secondary fibrinolysis, change of coagulation status and the risk of thrombosis. ② Heparin may not be enough to protect coagulation function changes caused by RFCA. ③An appro- priate amount of anticoagulant and antiplatelet activation medication should be used in patients of Right group to reduce the poten- tial risk of thrombosis after RFCA.

关 键 词：射频消融术 凝血功能 D-二聚体 肝素钠 

分 类 号：B541.4[哲学宗教—外国哲学]