射频消融术与迷走神经反射介导的心动过缓-低血压现象  

The Bradycardia and Hypotention Mediated by Vasovagal Reflex in the Radiofrquency Catheter Ablation.

作　　者：胡雪松[1] 虞准[2] 彭长农[2] 衣为民[2] 李忠红[2] 方卫华[2] 

机构地区：[1]广东省深圳市第二人民医院,广东深圳518035 [2]广东省深圳市孙逸仙心血管医院,广东深圳518001

出　　处：《中国心脏起搏与心电生理杂志》2002年第4期269-271,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：探讨射频消融术 (RFCA)前后出现的心动过缓 低血压现象的发生率、临床意义、发生机制及影响因素。 191例室上性心动过速患者接受RFCA ,其中左侧旁道和室性心动过速定为左心组 ,右侧旁道和房室结双经路定为右心组。RFCA过程中共有 19例发生心动过缓 低血压现象 ,术中出现者为术中发生 ,拔管后 30min内出现者为术后即刻发生 ,超过 30min者为术后延迟发生。结果 :RFCA过程中心动过缓 低血压现象发生率为 9.9% (19/ 191)。左心组显著多于右心组 11.2 %vs 8.3% (P <0 .0 5 ) ,右心组射频能量高于左心组 (P <0 .0 5 ) ,术后即刻、术中及术后延迟发生分别为 5 .2 %、2 .1%、2 .6 % (P <0 .0 1)。结论 :RFCA过程中发生的心动过缓 低血压现象由迷走神经反射介导 ,与导管刺激心脏以及血管受压有关 ,与射频能量无关 ,左心较右心敏感。The aim is to investigate the incidence,clinical significance,mechanisms and relative factors of the bradycardia and hypotention in the course of radiofrquency catheter ablation (RFCA).191 patients with PSVT who received RFCA were divided into left heart and right heart groups:Patients with left accessory pathway or ventricular tachycardia were included in the left heart group,and right accessory pathway or AV nodal reentrant tachycardia in the right heart group.19 of 191 patients (9.9%) developed bradycardia and hypotention perioperatively,which was more frequent in the left heart group (11.2% vs.8.3%,P<0.05).Radiofrequency energy of the right heart group was higher than that of left heart group( P <0.05).Perioperatively,the incidence of bradycardia and hypotention was significantly different in three intervals (immediately after operation,during operation and delayed occurrence),5.2%?2.1% and 2.6% respectively( P <0.01).Conclusions:Bradycardia and hypotention is mediated by vasovagal reflex in the course of RFCA and is associated with the stimulation of heart by catheter and compression of vessels.The left cardiac system is more sensitive than the counterpart.No relationship exists between the reflex and radiofrequency energy.

关 键 词：射频消融术 迷走神经反射 心动过缓 低血压 发生机制 影响因素 

分 类 号：R541.72[医药卫生—心血管疾病] R815[医药卫生—内科学]