单中心左心耳封堵术安全性及有效性研究  

A preliminary study on the efficacy and safety of the left atrial appendage closure in one center

作　　者：梁明[1] 王英芝 杨桂棠[1] 孙鸣宇[1] 金志清[1] 丁明英[1] 张奇 吕洋 韩雅玲[1] 王祖禄[1] LIANG Ming;WANG Ying-zhi;YANG Gui-tang;SUN Ming-yu;JIN Zhi-qing;DING Ming-ying;ZHANG Qi;LYU Yang;HAN Ya-ling;WANG Zu-lu(Department of Cardiology,The General Hospital of Shenyang Military Command,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2018年第10期1115-1118,共4页Clinical Journal of Medical Officers

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目

摘　　要：目的探讨非瓣膜性心房颤动(NVAF)患者行左心耳封堵术(LAAC)的安全性及有效性。方法选取自2014年7月至2017年11月于沈阳军区总医院心血管内科行LAAC的44例NVAF患者为研究对象。其中,18例患者置入LAmbre封堵器(A组),26例置入Watchman封堵器(B组)。观察两组患者围术期,术后3、6、12个月的安全性及有效性。结果两组患者封堵器置入成功率均为100. 0%,A组18例患者全部一次性释放成功,B组术中有3例(11. 5%)患者经历了回收封堵器。两组患者围术期均未发生封堵器表面血栓、心包积液、大出血及死亡事件。A组患者术后未出现心包积液,B组2例(7. 7%)患者术后出现微量心包积液; A组有1例(5. 6%)患者发现术后即刻残余漏,B组有4例(15. 4%)患者发现术后即刻残余漏,两组患者封堵器残余漏大小均≤3 mm。A组患者全部完成术后经食管超声心动图(TEE)复查,残余漏仍为1例(5. 6%);B组12例完成术后TEE复查,残余漏为4例(33. 3%)。随访期间,两组患者均未见封堵器表面血栓、大出血、缺血性及出血性脑卒中、体循环栓塞、死亡事件的发生。结论应用LAmbre及Watchman封堵器行LAAC均具有较高的置入成功率,对预防NVAF所致的脑卒中有良好的安全性和有效性,较小的残余漏不增加卒中及栓塞事件的发生率。To investigate the efficacy and safety of left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was performed on 44 cases of NVAF patients with LAAC who were admitted from July 2014 to November 2017.Among the patients,there were 18 cases implanted with LAmbre closures in Group A,and 26 cases were implanted with Watchman closures in Group B.The results of safety and efficacy of all patients in perioperative period and during the periods of follow-up in 3,6 and 12 months after the procedures were compared.Results The success rates of closure implantation were 100%in both groups.All 18 patients in Group A succeeded in one release,and 3 cases(11.5%)experienced a retraction of the closures.No thrombus,pericardial effusion,hemorrhage or death occurred during the perioperative period.There was no pericardial effusion in Group A,2 cases(7.7%)had micropericardial effusion after operation.Residual leakage occurred in 1 case(5.6%)in Group A and in 4 cases(15.4%)in Group B.The residual leakage in both groups was less than 3 mm.There was no significant difference in the incidence of pericardial effusion and residual leakage between the two groups.All patients in Group A completed postoperative transesophageal echocardiography(TEE)review,and the residual leakage was still 1 case(5.6%).Postoperative TEE review was completed in 12 patients in Group B,and residual leakage was observed in 4 patients(33.3%).During the follow-up period,no thrombus,massive hemorrhage,ischemic and hemorrhagic stroke,systemic embolization,or death occurred in the two groups.Conclusion The application of LAmbre and Watchman sealing device to LAAC has a higher success rate of implantation,which has a good safety and effectiveness for the prevention of stroke caused by NVAF,and a small residual leakage does not increase the incidence of stroke and embolism.

关 键 词：非瓣膜性心房颤动 左心耳封堵术 卒中 左心耳 

分 类 号：R541.7[医药卫生—心血管疾病]