不同术者采用二代冷冻球囊消融治疗阵发性心房颤动学习曲线分析  

Learning curve of second-generation cryoballoon ablation for treatment of paroxysmal atrial fibrillation in different surgeons

作　　者：项冉 邵梦娇 商鲁翔 石佳 芦颜美[1] 张文慧[1] 李耀东[1] 汤宝鹏[1] 周贤惠[1] XIANG Ran;SHAO Meng-jiao;SHANG Lu-xiang;SHI Jia;LU Yan-mei;ZHANG Wen-hui;LI Yao-dong;TANG Bao-peng;ZHOU Xian-hui(Heart Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2020年第1期15-20,共6页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区自然科学基金(2016D01C306)。

摘　　要：目的探讨本中心2名术者应用二代冷冻球囊术(second-generation cryoballoon,2G-CB)行初次肺静脉隔离(pulmonary vein isolation,PVI)治疗阵发性心房颤动(paroxysmal atrial fibrillation,PAF)的学习曲线、即刻成功率及安全性。方法回顾性选取2017年9月至2019年3月在新疆医科大学第一附属医院心脏中心接受2G-CB的药物难治型PAF,两位术者连续60例,共120例患者的临床资料。通过先后顺序分为6组(每组10人,分为时序1〜6组),比较各组的手术时间,胸部X线曝光时间及即刻PVI成功的差异。结果120例患者,分为术者1组和术者2组,两组平均年龄为(59.52±10.12)岁比(62.91±11.91)岁(P=0.097),男性比例为66.7%比60.0%(P=0.449),心房颤动病程为(15.62±9.10)月比(13.9H8.71)月(P=0.297),冷冻次数中位数为2(2-3)次比2(2-4)次(P=0.092),差异均无统计学意义。术者2组手术时间[(65.4±16.8)min比(59.4±13.5)min,P=0.033]及胸部X线曝光时间[(18.7±4.2)min比(16.8±3.5)min,P=0.013]均长于术者1组。术者1经过约20例手术后单次手术的操作时间(P=0.007)和胸部X线曝光时间显著缩短;术者2经过约30例单次手术的操作时间(PV0.001)和胸部X线曝光时间显著缩短,患者水平及静脉水平冷冻球囊的即刻PVI成功率显著升高,并达到一个稳定的水平。术者1组共出现2例膈神经麻痹,2例心包积液。术者2组出现3例膈神经麻痹,1例心包积液,1例术后语言障碍。结论应用2G・CB行PVI治疗PAF具有即刻有效性和安全性。不管是房颤消融经验丰富的术者还是缺乏房颤消融经验的术者都可较快的完成学习曲线。Objective To explore the learning curve,immediate success rate and safety of primary pulmonary vein isolation(PVI)for paroxysmal atrial fibrillation(PAF)in two surgeons with second-generation cryoballoon(2G-CB).Methods The clinical data of 120 patients with refractory PAF who received 2G-CB from September 2017 to March 2019 were retrospectively selected at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University.Sequentially divided into 6 sub-groups for 2 doctors'group(10 persons in each group,divided into time series 1 to 6),the differences in operative time,X-ray exposure time and immediate PVI success were compared between the groups.Results The 120 patients were divided into group 1 and group 2;the mean ages of the two groups was(59.52±10.12)years old vs.(62.91±11.91)years old(P=0.097);the male ratio was 66.7%vs.60.0%(P=0.449);the course of atrial fibrillation was(15.62±9.10)months vs.(13.91土8.71)months(P=0.297);the median number of freezes times was 2(2-3)times vs.2(2-4)times(P=0.092);the difference was not statistically significant.Compared with the surgeon 1,the surgeon 2 operation time[(65.4±16.8)min vs.(59.4±13.5)min,P=0.033]and an X-ray exposure time[(18.7±4.2)min vs.(16.8±3.5)min,P=0.013]were longe匚The operation time(P=0.007)and X-ray exposure time of the surgeon 1 of a single operation after about 20 cases were significantly shortened.The operation time(P<0.001)and X-ray exposure time of the surgeon 2 after approximately 30 operations were significantly shortened.The immediate PVI success rate of the patient's level and venous level frozen balloon was significantly increased and reached a stable level.There were 2 cases of phrenic nerve palsy and 2 cases of pericardial effusion in the group 1.In the group 2,3 patients had phrenic nerve palsy and 1 patient had pericardial effusion and 1 patient had postoperative language disorde匚Conclusion PVI with the 2G-CB for PAF has immediate efficacy and safety.A surgeon whether who is experienced in atrial fibrillation ablati

关 键 词：阵发性心房颤动 冷冻球囊 学习曲线 

分 类 号：R541.7[医药卫生—心血管疾病]