心房颤动射频消融术并发急性心脏压塞心包穿刺的早期拔管临床分析  

Clinical analysis of early removal of the pericardial drain in the patients with acute cardiac tamponade complicating radiofrequency ablation of atrial fibrillation

作　　者：赵倩倩 李林凌 刘念[1] 张梦夏 阮燕菲[1] 闻松男[1] 白融[1] 杜昕[1] 董建增[1] 马长生[1] ZHAO Qianqian;LI Linling;LIU Nian;ZHANG Mengxia;RUAN Yanfei;WEN Songnan;BAI Rong;DU Xin;DONG Jianzeng;MA Changsheng(Department qf Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2019年第3期221-224,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81670291;81770318;81870244)

摘　　要：目的:分析心房颤动射频消融术并发急性心脏压塞心包引流后导管早期拔管的安全性及临床疗效。方法:回顾性分析2005年1月至2018年7月,北京安贞医院行射频消融术并发急性心脏压塞经心包引流的心房颤动患者,分为导管早期拔管组(ER组)和延迟拔管组(DR组),两组进行临床比较。结果:共纳入急性心脏压塞心包引流患者51例, ER组25例,DR组26例,两组基线特征差异无统计学意义。DR组术中心包引流量显著高于ER组[250(205,400)vs.440(310,700)mL,P=0.002]。两组术后无一例再次出现心脏压塞征象,DR组7例患者于拔管前从引流管抽出淡红色液体(≤70 mL)。术后与DR组相比,ER组胸痛率(24.0%vs.88.5%,P=0.000)、发热率(24.0%vs.69.2%,P=0.001)、恶心发生率(零vs.42.3%,P=0.000)、术后院内心房颤动复发率(16.0%vs.50.0%,P=0.010)、抗生素使用率(52.0%vs.84.6%,P=0.012)均较低,重启抗凝治疗[15.5(11.4,21.9)vs.26.8(16.1,36.0)h,P=0.009]较早,术后住院时间[3(2,3)vs.5(3,9)d,P=0.001]较短。结论:心房颤动射频消融于导管并发急性心脏压塞心包引流后,导管早期拔管是安全的,显著改善术后患者的医疗和生活质量,缩短术后住院日,临床上值得借鉴和推广。Objective: To analyze the safety and clinical efficacy of early pericardial drain removal in patients with acute cardiac tamponade complicating radiofrequency ablation of atrial fibrillation(RAAF). Methods: All RAAF performed at Beijing Anzhen Hospital between January 2005 to July 2018 were retrospectively enrolled. The patients were then divided into earty removal(ER)group in the electrophysiology(EP) laboratory and delayed removal(DR) group in the ward. Results: A total of 51 patients were included, 25 patients in the ER group and 26 patients in the DR group respectively. There were no significant differences in baseline characteristics between 2 groups. The pericardial effusion drained in the DR group was more than ER group(P=0.002) and 7 patients were extracted damask liquid(≤70 mL) in the ward. No cardiac tamponade reoccurred in both gorup in the ward. The rate of pectoralgia(P=0.000), fever(P=0.001), nausea(P=0.000), in-hospital recurrent AF(P=0.010) and the usage of antibiotics(P=0.012) were lower, re-anticoagulation was earlier(P=0.009) and the median inhospital stay was shorter(P=0.001) in the ER group than DR group. Conclusions: Early removal of the pericardial drain in the patients with ponade complicating RAF is safe and result in high-quality, cost-effective and an decreased median hospital stay.

关 键 词：心房颤动 导管消融 心脏压塞 早期拔管 

分 类 号：R54[医药卫生—心血管疾病]