左心耳封堵术与华法林对非瓣膜性房颤病人卒中预防的有效性及安全性对照研究  

Comparative Study on Efficacy and Safety of Left Atrial Appendage Occlusion and Warfarin for the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation

作　　者：王军[1] 张松林[1] 何璐[1] 范粉灵[1] 张玉顺[1] Wang Jun;Zhang Songlin;He Lu;Fan Fenling;Zhang Yushun(The First Affiliated Hospital of Xi'an Jiao Tong University,Xi’an 710061,Shaanxi China)

机构地区：[1]西安交通大学第一附属医院,西安710061

出　　处：《中西医结合心脑血管病杂志》2018年第6期738-741,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：国家自然科学基金面上项目(No.81170294);陕西省科技统筹创新计划(No.2014KTCL03-11)

摘　　要：目的对比非瓣膜性心房颤动(NVAF)应用华法林(WAR)与左心耳封堵术(LAAO)治疗在卒中预防上的有效性和安全性。方法以2014年1月—2016年6月接受左心耳封堵术治疗的54例NVAF病人为LAAO组,并以同期使用华法林治疗的54例NVAF病人为WAR组。在每位病人出院后1个月、3个月、6个月、12个月时进行随访,观察两组在随访期内卒中预防的有效性和安全性。结果两组出院后1个月、3个月、6个月、12个月随访时均无体循环栓塞、心血管死亡及脑卒中等有效性终点事件发生。LAAO组病人手术均成功植入左心耳封堵器,成功率100.0%;术后出现5例残余分流,分流量依次为2 mm、1 mm、1 mm、3 mm、2 mm,术后3个月随访时残余分流均消失。LAAO组术后无大出血、封堵器表面血栓形成等并发症;仅有4例出现包心积液,及时予以保守对症处理后,于术后3个月随访时消失。术后1年随访中两组均无死亡、心脏压塞、器械相关栓塞等不良事件发生。LAAO组随访3个月后出血事件及1年内总出血事件发生率分别为0.0%、9.3%,均明显低于WAR组的16.7%、27.8%(P<0.05)。术后1年随访期内在出血类型上,两组相比均无统计学意义(P>0.05)。结论 NVAF应用左心耳封堵术治疗在预防卒中方面有效性不劣于华法林,但安全性优于华法林。Objective To compare the efficacy and safety of left atrial appendage ocllusion(LAAO)and warfarin(WAR)for the prevention of stroke in patients with non-valvular atrial fibrillation(NVAF).Methods Fifty four patients with NVAF who accepted LAAO in our hospital from January 2014 to June 2016 were selected as LAAO group,and 54 patients with NVAF who accepted warfarin during the identical time period were selected as WAR group.Follow-up were carried out at 1 month,3 months,6 months,and 12 months after discharge.The efficacy and safety of stroke prevention in two groups were observed and compared.Results There was no systemic embolism,cardiovascular death,or stroke in two groups at 1 month,3 months,6 months,and 12 months after discharge.The success rate of LAAO device implantation was 100.0%in LAAO group.After operation 5 cases of residual shunt were found,with volumes of 2 mm,1 mm,1 mm,3 mm,2 mm.The residual shunt disappeared after 3 months of the operation.There was no complications like hemorrhoea or thrombus on occlusion device in LAAO group after operation.Four cases of hydropericardium were found and treated accordingly.At the time of 3 months after operation,hydropericardium was not seen any more.Within one year of follow-up,there was no advent event of death,cardiac tamponade,equipment related embolism in two groups.The incidence of hemorrhoea in LAAO group 3 months after operation and 1 year after operation were 0.0%and 9.3%,respectively,which were significantly lower than that in WAR group(13.0%and 27.8%,P<0.05).Conclusion LAAO is not inferior to warfarin in efficacy and superior to warfarin in safety in patients with NVAF.

关 键 词：非瓣膜性心房颤动 左心耳封堵术 华法林 卒中预防 安全性 

分 类 号：R541.7[医药卫生—心血管疾病] R256.2[医药卫生—内科学]