肺静脉内不同温度射频消融对血液动力学的影响  

The Effects of Radiofrequency Catheter Ablation Within Pulmonary Veins Using Various Temperatures On Hemodynamics.

作　　者：吴钢[1] 黄从新[1] 江洪[1] 李庚山[1] 漆曙辉[1] 杨新红[1] 杨剑雪[1] 王洪如[1] 王小红[1] 许辉[1] 

机构地区：[1]武汉大学人民医院心内科,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2001年第2期104-106,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨用不同预置温度行肺静脉内射频消融对血液动力学的影响。选择健康杂种犬 3 0只 ,分成 5 0℃ ,60℃ ,70℃三组 ,经房间隔途径将温控电极置入肺静脉内进行消融 ,消融时间均为 60s。消融前、消融后即刻监测心电图 ,行选择性肺静脉造影 ,并测量右房压 (RAP)、右室压 (RVP)、主肺动脉压 (PAP)、左房压 (LAP)。术后留养 3个月 ,重复以上检查。结果 :5 0℃组 1只犬在行房间隔穿刺时因心包填塞死亡 ,其余均顺利完成试验。共在 72处肺静脉内行点状消融 ,5 0℃、60℃、70℃组分别为 2 0 ,2 6,2 6处。右上、下肺静脉 ,左上、下肺静脉分别为 13 ,9,2 7,2 3处。 5 0℃及 60℃组消融后即刻、术后 3个月血液动力学指标无显著变化 ;70℃组消融后即刻、术后 3个月肺动脉压分别为 3 5± 7,3 3± 5mmHg,较术前 ( 2 8± 4mmHg)明显升高 (P <0 .0 5 ) ;左房压分别为 11± 4 ,12± 2mmHg ,较术前 ( 14± 3mmHg)显著降低 (P <0 .0 5 ) ;70℃组肺静脉狭窄的发生率均明显高于 60℃组及 5 0℃组。结论 :肺静脉内射频消融影响血液动力学的原因主要是肺静脉狭窄 ;消融温度在 60℃和 70℃之间存在影响血液动力学的临界值 ,故预置温度应控制在 60℃以内。To study the effects of radiofrequency catheter ablation (RFCA) in pulmonary veins (PV) using various temperatures on hemodynamic parameters.Thirty dogs were divided into 3 groups,The RFCA temperature of each group was 50 ℃,60 ℃,70 ℃ respectively.All of the ablation time was 60s.Radiofrequency catheter was positioned in the PVs via a transseptal approach under fluoroscopic after pulmonary arteriography.Selective pulmonary venography was undertaken and the hemodynamic data were measured before ablation,immediately after ablation and three month later.Results:One dog of 50 ℃ group died of tamponade.RFCA applied to right superior PV (RSPV),right inferior PV (RIPV),left superior PV (LSPV),left inferior PV (LIPV) were13,9,27,23 respectively.RFCA applied to 50 ℃,60 ℃,70 ℃ group were 20,26,26 respectively.No significant change of hemodynamic parameters was observed in 50 ℃and 60 ℃ group.While in 70 ℃ group,compared with pre-ablation,PAP was significantly higher and LAP was significantly lower immediately after RFCA (35±7 vs 28±4 mmHg,11±4 vs 14±3 mmHg;P<0.05)and 3 month later(33±5 vs 28±4 mmHg,12±2 vs 14±3 mmHg;P<0.05).The incidence of PV stenosis was significantly higher in 70 ℃ group than in 50 ℃,60 ℃ group.Conclusion:PV stenosis is the important reason of hemodynamic abnormal caused by RFCA within PVs.There is a critical temperature among 60 ℃～70 ℃ using which RFCA in PVs will have significant effects on hemodynamic parameters.The temperature of RFCA in PVs should controlled below 60 ℃.

关 键 词：肺静脉 射频消融 消融温度 血液动力学 心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]