经皮左心耳封堵联合冠状动脉介入“一站式”治疗对心房颤动合并冠心病患者的安全性及疗效初探  

Preliminary study on the safety and efficacy of one-stop treatment of percutaneous left atrial appendage closure combined with coronary intervention for patients with atrial fibrillation complicated with coronary heart disease

作　　者：姜小飞 朱卫民 李军 张恒 曾杰[3] JIANG Xiao-fei;ZHU Wei-min;LI Jun;ZHANG Heng;ZENG Jie(Department of Cardiology,Zhuhai People's Hospital,Zhuhai 519000,China)

机构地区：[1]珠海市人民医院心内科,广东省珠海市519000 [2]珠海市人民医院超声科,广东省珠海市519000 [3]四川省人民医院心内科

出　　处：《中国心血管病研究》2019年第1期73-77,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨对非瓣膜性心房颤动(房颤)合并冠心病的患者,同期进行经皮左心耳封堵术联合冠状动脉介入一站式治疗的可行性、安全性及疗效。方法回顾性分析珠海市人民医院2017年4月至2018年6月收治的5例房颤合并冠心病的患者的临床资料。所有患者术后服用阿司匹林100 mg qd+氯吡格雷75 mg qd双抗1年,阿司匹林/氯吡格雷单抗长期使用的方案。术后即刻评价左心耳封堵及冠状动脉介入疗效,并于术后45、90 d随访观察左心耳封堵器的位置、血栓形成以及残余分流情况及患者临床表现。结果5例患者均成功置入WATCHMAN左心耳封堵器及冠状动脉支架。术后即刻封堵效果满意,WATCHMAN封堵器符合PASS原则,冠状动脉介入治疗效果满意。术中无器械表面血栓,无心包压塞及血管并发症。随访结果显示,5例患者无出现卒中、心功能恶化者、封堵器移位、封堵器残余分流加重及器械表面血栓、心绞痛或心梗事件,且亦未发现皮肤瘀斑、消化道出血、脑出血等出血事件。结论对非瓣膜性房颤合并冠心病患者,同期实施左心耳封堵术联合冠状动脉介入一站式治疗的安全性可靠,有一定的可行性,近、中期的随访效果良好。Objective To explore the feasibility,safety and efficacy of one-stop treatment of percutaneous left atrial appendage closure combined with coronary intervention for patients with non-valvular atrial fibrillation complicated with coronary heart disease.Methods Retrospectively analyzing the clinical data of 5 patients with atrial fibrillation combined with coronary heart disease admitted to Zhuhai People's Hospital from April 2017 to June 2018.After the operation,all the patients were treated with Aspirin 100 mg qd and Clopidogrel 75 mg qd for 1 year and a long-term use of Aspirin/Clopidogrel.The effects of left atrial appendage closure and coronary intervention were evaluated immediately.The location of left atrial appendage closure,thrombosis and residual leak and clinical manifestations were observed at day 45 and day 90 after the operation.Results Five patients were successfully implanted with WATCHMANTM device and coronary stents.After the operation,the immediate sealing effect was satisfactory.The WATCHMANTM occluder was in accordance with the PASS principle and the coronary intervention was satisfactory.During operation,there was no device-related thrombosis,no tamponade and vascular complications.Follow-up results showed that in 5 patients there were no hemorrhagic stroke, worsening heart function,device dislocation,slubber residual leak and device-related thrombosis,angina pectoris or myocardial infarction;and no skin ecchymosis,gastrointestinal bleeding and cerebral hemorrhage occurred. Conclusion For patients with non-valvular atrial fibrillation combined with coronary heart disease,the safety and feasibility of one-stop treatment with left atrial appendage closure and coronary intervention can be reliable,the short and medium term follow up of curative effect were also satisfactory.

关 键 词：冠状动脉疾病 心房颤动 左心耳封堵术 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]