在局部麻醉下行改良房间隔穿刺技术指导左心耳封堵器植入的研究  

Left Atrial Appendage Occlusion Under the Guidance of Local Anesthesia and Modified Transseptal Puncture Technology

作　　者：郑黎晖[1] 吴灵敏[1] 孙巍[1] 郭金锐[1] 乔宇[1] 丁立刚[1] 陈刚[1] 姚焰[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心,北京市100037

出　　处：《中国循环杂志》2017年第7期646-649,共4页Chinese Circulation Journal

基　　金：国家自然科学基金(81600275)

摘　　要：目的:探讨局部麻醉和冠状静脉窦辅助定位的改良房间隔穿刺技术指导下行左心耳封堵术的安全性和有效性。方法:16例非瓣膜性心房颤动(房颤)患者,男性12例,平均年龄(71.0±6.0)岁,CHA_2DS_2-VASc评分为(4.1±1.5)分,均为华法林治疗禁忌证或华法林相关不良反应者,于局部麻醉下行经皮LAmbre或Amplatzer Cardiac Plug左心耳封堵器植入,均应用冠状静脉窦导管作为解剖标志完成房间隔穿刺。结果:16例患者均顺利完成房间隔穿刺,无穿刺相关并发症发生。15例(94%)患者左心耳封堵成功,1例患者因左心耳解剖结构特殊放弃封堵。平均手术时间为(65.0±23.0)min,X线曝光时间(12.0±3.0)min。植入封堵器的固定盘平均直径(32.5±6.0)mm。结论:局部麻醉下,以冠状静脉窦导管作为解剖标志指导房间隔穿刺行左心耳封堵术总体而言安全、有效。Objective： To explore the safety and efficacy of left anesthesia and modified transseptal puncture technology by atrial fibrillation （NVAF）. atrial appendage （LAA） occlusion under the guidance of local coronary sinus assisted positioning in patients with nonvavular Methods： A total of 16 NVAF patients received local anesthesia and percutaneous LAmbre or Amplatzer cardiac plug occluder implantation. There were 12 males and the patients mean age was at （71.0±6.0） years with CHA2DS2-VASc score at （4.1±1.5）; all patients had walfarin contradiction or with walfarin related side effect. Transseptal puncture was conducted by coronary sinus catheter as the anatomic location marker. Results： All 16 patients finished transseptal puncture and no relevant complication occurred. 15/16 （93.8%） patients had successful LAA occlusion, 1 patient was abandoned because of LAA anatomic structure variation. The mean operative time was （65.0±23.0） min and the mean X-ray exposure time was （12.03±3.0） min. The mean diameter of occluder was （32.5±6.0）mm. Conclusion： LAA occlusion was safe and effective with local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in relevant patients.

关 键 词：心房颤动 左心耳封堵术 麻醉 局部 

分 类 号：R541[医药卫生—心血管疾病]