Watchman左心耳封堵术与口服利伐沙班对非瓣膜性房颤患者卒中预防的效果  

Effects of Watchman left atrial appendage closure and oral rivaroxaban on stroke prevention in patients with non-valvular atrial fibrillation

作　　者：赵宏伟[1] 尹晓盟[2] 王成福[1] 侯培培[1] 王永 朱宇 ZHAO Hong-wei;YIN Xiao-meng;WANG Cheng-fu;HOU Pei-pei;WANG Yong;ZHU Yu(Department of Cardiology,the People's Hospital of Liaoning Province,Shenyang,110016,Liaoning,China;Department of Cardiology,the First Affiliated Hospital of Dalian Medical University,Dalian,116000,Liaoning,China)

机构地区：[1]辽宁省人民医院心内科,辽宁沈阳110016 [2]大连医科大学附属第一医院心内科,辽宁大连116000

出　　处：《心脏杂志》2019年第6期673-676,共4页Chinese Heart Journal

基　　金：辽宁省自然科学基金指导计划项目资助(201602434)

摘　　要：目的分析Watchman左心耳封堵术(LAAC)与口服利伐沙班对非瓣膜性房颤(NVAF)患者卒中预防的效果。方法选取2016年5月~2017年3月在辽宁省人民医院及大连医科大学附属第一医院心血管内科接受LAAC治疗的30例NVAF患者作为LAAC治疗组,及同期接受利伐沙班治疗的30例NVAF患者作为利伐沙班治疗组。两组患者均在出院后第1、3、6、9、12个月及之后每半年进行安全性和有效性评价,随访截止至2019年3月31日。结果两组NVAF患者随访结果显示:LAAC治疗组无缺血性卒中、出血性卒中及系统性栓塞事件发生,利伐沙班治疗组有2例缺血性卒中,2例系统性栓塞,1例出血性卒中发生,虽然两组各单项心血管事件发生率均无显著差异,但LAAC治疗组心血管事件总发生率显著低于利伐沙班治疗组患者(P <0.05)。LAAC治疗组未发生颅内出血、栓塞及临床相关卒中事件,无消化道出血;利伐沙班治疗组有1例患者发生颅内出血,2例发生栓塞,无消化道出血,3例发生临床相关卒中;两组各单项不良事件发生率的差异均无统计学意义,但LAAC治疗组不良事件总发生率显著低于利伐沙班治疗组(P <0.05)。LAAC治疗组患者均成功植入Watchman左心耳封堵器,术后出现9例残余分流,无严重残余分流(> 5 mm)现象;患者均未出现器械移位和器械血栓形成事件。结论 NVAF患者使用Watchman LAAC治疗在卒中预防中的有效性和安全性均优于口服利伐沙班治疗。AIM To analyze the effects of Watchman left atrial appendage closure(LAAC)and oral rivaroxaban on stroke prevention in patients with non-valvular atrial fibrillation(NVAF).METHODS 30 NVAF patients treated with LAAC in the Department of Cardiovascular Medicine of the People's Hospital of Liaoning Province and the First Affiliated Hospital of Dalian Medical University from May 2016 to March 2017 were selected as LAAC treatment group,and 30 NVAF patients treated with rivaroxaban in the same period were selected as rivaroxaban treatment group.The safety and effectiveness of the two groups were evaluated at the first,third,sixth,ninth,twelfth months after discharge and every six months after discharge.The follow-up period was up to 31 March 2019.RESULTS The follow-up results of NVAF patients in two groups showed that there were no ischemic stroke,hemorrhagic stroke and systemic embolism in LAAC treatment group,there were 2 cases of ischemic stroke,2 cases of systemic embolism and 1 case of hemorrhagic stroke in rivaroxaban treatment group,although there was no significant difference in the incidence of individual cardiovascular events between the two groups,however,the total incidence of cardiovascular events in LAAC group was significantly lower than that in Rivaroxaban group.There were no intracranial hemorrhage,embolism and clinically related stroke in LAAC treatment group,and no gastrointestinal hemorrhage occurred;while in rivaroxaban treatment group,1 case had intracranial hemorrhage,2 cases had embolism,no gastrointestinal hemorrhage occurred and 3 cases had clinically related stroke;there was no significant difference in the incidences of adverse events between the two groups,but the total incidence of adverse events in LAAC group was significantly lower than that in Rivaroxaban group(P>0.05).All the patients in LAAC treatment group were successfully implanted with Watchman left atrial appendage occluder,there were 9 cases of residual shunt and no severe residual shunt(>5 mm).No device displacement or device t

关 键 词：非瓣膜性房颤 左心耳封堵术 利伐沙班 卒中 有效性 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]