导管射频消融术对老年持续性心房颤动的疗效及围手术期抗凝药物安全性分析  

Clinical efficacy of the radiofrequency catheter ablation in elderly patients with persistent atrial fibrillation and safety analysis of anticoagulant drugs during the perioperation

作　　者：钱炜春[1] 王向明 许健 褚明 QIAN Wei-chun,WANG Xiang-ming2, XU Jian2, CHU Ming2.(1Department of Cardiology,Nanjing First Hospital, Nanjing 210006, China; 2 Department of Geriatric Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Chin)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心脏内科,江苏省南京市210006 [2]南京医科大学第一附属医院老年心血管内科,江苏省南京市210029

出　　处：《实用老年医学》2018年第7期643-645,共3页Practical Geriatrics

基　　金：南京市医学科技发展项目(YKK17115);江苏省干部保健课题(BJ17019)

摘　　要：目的探讨导管射频消融术(RFCA)对老年持续性心房颤动的疗效及围手术期抗凝药物的安全性。方法采用回顾性研究方法,入选南京医科大学第一附属医院接受RFCA的持续性房颤病人140例,按年龄分为老年组(67例)和非老年组(73例)。比较2组病人的临床特点、RFCA术后房颤复发率和围手术期出血发生率。比较老年组病人中,使用达比加群酯与华法林围手术期抗凝治疗出血发生率。结果老年组病人合并高血压和糖尿病的比例、心功能分级及非瓣膜性房颤脑卒中风险(CHA2DS2-Vasc)评分均高于非老年组,差异有统计学意义(P<0.05)。2组间RFCA术后房颤的复发率差异无统计学意义(P>0.05)。老年组病人中,达比加群酯在围术期抗凝治疗的安全性高于华法林,差异具有统计学意义(P<0.05)。结论 RFCA是针对老年持续性房颤病人治疗的有效方法。达比加群酯在围术期抗凝治疗的安全性高于华法林,可作为老年持续性房颤RFCA围手术期的抗凝药物。Objective To investigate the clinical efficacy of the radiofrequency catheter ablation（RFCA） in elderly patients with persistent atrial fibrillation and to analyze the safety of anticoagulant drugs during the perioperation. Methods A total of 140 elderly patients with persistent atrial fibrillation who received RFCA were enrolled in this study. Patients were divided into elderly group（n = 67） and nonelderly group（n = 73）. Recurrence rate of atrial fibrillation and perioperative hemorrhage after RFCA and clinical features were compared between two groups. Also,the incidence rate of haemorrhage during perioperation was compared between patients in elderly group who used dabigatran or warfarin. Results The proportion of hypertension and diabetes,cardiac functional grading and CHA2 DS2-Vasc grading in elderly group were higher than those in non-elderly group（P 〈0. 05）. However,there was no significant difference in the recurrence rate of atrial fibrillation after RFCA between two groups（P〉0. 05）. The patients in elderly group who received dabigatran had higher anticoagulation safety than those using warfarin during perioperative period（P〈0. 05）. Conclusions RFCA can be used as an effective method for the treatment of persistent atrial fibrillation in the elderly patients. The anticoagulation safety of dabigatran during perioperation was higher than that of warfarin. Dabigatran can be used as an anticoagulant drug during perioperation after RFCA in elderly patients with persistent atrial fibrillation.

关 键 词：老年人 持续性心房颤动 导管射频消融术 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]