较低活化凝血时间下心房颤动消融术并发症的发生率及出血并发症的危险因素  

Complication rate and risk factors for bleeding during atrial fibrillation ablation under lower activated clotting times

作　　者：张波[1] 凌智瑜[1] 苏立[1] 杜华安[1] 肖培林[1] 刘增长[1] 殷跃辉[1] ZHANG Bo LING Zhi-yu SU Li DU Hua-an XIAO Pei-lin LIU Zeng-zhang YIN Yue-hui(Cardiovascular Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学附属第二医院心内科重庆市心律失常治疗中心,重庆400010

出　　处：《心脏杂志》2017年第1期60-64,共5页Chinese Heart Journal

摘　　要：目的观察和分析较低活化凝血时间(ACT)条件下心房颤动(房颤)消融术的安全性及其主要并发症的危险因素。方法收集并整理于我院行射频或冷冻球囊消融术的231例房颤患者的临床资料。按消融术中所测ACT的平均值(以下简称ACT)分为<200 s,200~<250 s和≥250 s 3组,计算并比较各组栓塞及出血并发症的发生率,再按是否发生出血并发症分为出血并发症组和未出血并发症组,按病例对照研究进行单因素分析和多因素logistic回归分析,分析出血并发症的危险因素。结果全部患者发生并发症13例,总发生率为5.6%,<200 s,200~<250 s和≥250 s 3组的总发生率分别为4%、3%和13%,≥250组总发生率显著高于200~<250 s组(P<0.05)。≥250 s组出血并发症发生率显著高于200~<250 s组(11%vs.1%,P<0.01),3组其他并发症无显著差异。多因素logistic回归分析结果提示手术耗时(P<0.01,OR=1.025,95%CI:1.007~1.043)、公斤体质量肝素注射量(P<0.01,OR=1.067,95%CI:1.020~1.116)及术中ACT(P<0.01,OR=1.065,95%CI:1.017~1.114)是出血并发症的独立危险因素。结论对CHADS2评分<2分的房颤患者,将消融术中ACT维持在200~<250 s是相对安全的。手术耗时、公斤体质量肝素注射量及术中ACT是发生出血并发症的独立危险因素。AIM To observe and analyze the risk factors for major complications and the safety of atrial fibrillation （AF） ablation under lower activated clotting times （ACTs）. METHODS Clinical data of 231 AF patients who underwent radiofrequency or cryoballoon ablation were collected. According to the value of averaged ACT during ablation procedure, patients were divided into three groups： average ACT 〈200 s, 200-250 s and ≥250 s. Embolie and bleeding complication rates of each group were analyzed. Patients were then categorized into bleeding group and non-bleeding group according to the occurrence of bleeding complications. In this case-control study, uni- and multivariate logistic regression analysis were performed to identify the predictors of bleeding complications. RESULTS Complications occurred in 13 （5.6%） patients. The total complication rates in groups of 〈200 s, 200 -250 s and ≥250 s were 4% , 3% and 13% , respectively, which was much higher in the 〉250 s group than in the 200 -250 s group （P 〈0.05）. Compared with the 200 -250 s group, bleeding complication rate of ≥ 250 s group was much higher （ 11% ：1% , P 〈0. 01 ）. Differences in other complications among the three groups were not significant. Multivariate logistic regression analysis indicated that the total procedural time （ P 〈 0. 01, OR = 1. 025, 95%CI： 1. 007 - 1. 043）, heparin bolus normalized for body weight （P 〈0. 01, OR = 1. 067,95%CI： 1. 020- 1. 116） and averaged ACT （P 〈0. 01, OR = 1. 065, 95%CI： 1. 017 - 1. 114） during ablation procedure were independent risk factors for bleeding complications. CONCLUSION AF ablation is relatively safe with a target ACT of 200 - 250 s for patients with CHADS2 scores 〈 2. Furthermore, total procedural time, heparin bolus normalized for body weight and average ACT during ablation procedure prove to be independent predictors of bleeding complications.

关 键 词：心房颤动 活化凝血时间 消融术 并发症 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病]