房颤患者术后医源性房间隔缺损发生情况及影响因素分析  

Analysis of the occurrence and influencing factors of postoperative iatrogenic atrial septal defect in patients with atrial fibrillation

作　　者：武思雯 张荣峰[2] 尹晓盟[2] 董颖雪[2] 肖宪杰 高连君[2] WU Siwen;ZHANG Rongfeng;YIN Xiaomeng;DONG Yingxue;XIAO Xianjie;GAO Lianjun(Department of Cardiology,Panjin Central Hospital,Liaoning Province,Panjin 124000,China;Department of Cardiology,the First Affiliated Hospital of Dalian Medical University,Liaoning Province,Dalian 116011,China)

机构地区：[1]辽宁省盘锦市中心医院心内科,辽宁盘锦124000 [2]大连医科大学附属第一医院心内科,辽宁大连116011

出　　处：《中国医药导报》2020年第11期44-47,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81800294)。

摘　　要：目的了解房颤患者术后医源性房间隔缺损(ASD)的发生情况及影响因素,为医源性ASD的预防和治疗提供依据。方法选取2014年12月~2017年12月大连医科大学附属第一医院行房间隔穿刺术的118例房颤患者纳入研究。根据术后经胸超声心动图(TTE)或经食道超声心动图(TEE)检测结果,将患者分为医源性ASD组(n=18)及正常愈合组(n=83),比较两组临床资料,分析医源性ASD的影响因素。对医源性ASD患者进行3个月的随访,观察医源性ASD患者预后。结果医源性ASD组术式均为射频消融术,剔除正常愈合组行左心耳封堵术10例及冷冻球囊消融术7例。随访3个月发现有1例出现腔隙性脑梗死,2例偏头痛。医源性ASD组中持续性房颤发生率、国际标准化比值高于正常愈合组(P<0.05),左房内径大于正常愈合组(P<0.05)。logistic回归分析显示左房内径>38 mm是发生医源性ASD的独立危险因素(OR=1.119,95%CI:1.006~1.245,P=0.038)。结论房颤射频消融术后医源性ASD较为常见,左房内径增大是导致医源性ASD的独立危险因素,医源性ASD仍可以导致临床事件发生,应引起重视。Objective To investigate the occurrence and influencing factors of postoperative iatrogenic atrial septal defect(ASD)in patients with atrial fibrillation,and to provide evidence for the prevention and treatment of iatrogenic ASD.Methods From December 2014 to December 2017,118 cases with atrial fibrillation who underwent atrial septal puncture in the First Affiliated Hospital of Dalian Medical University were selected.According to the results of transthoracic echocardiography(TTE)or transesophageal echocardiography(TEE),they were divided into iatrogenic ASD group(n=18)and normal healing group(n=83).The clinical data of two groups were compared and the influencing factors of iatrogenic ASD were analyzed.The patients with iatrogenic ASD were followed up for 3 months and the prognosis was observed.Results In iatrogenic ASD group,all patients underwent radiofrequency ablation.Ten cases who underwent left atrial appendage occlusion and 7 cases who underwent frozen balloon ablation were excluded in normal healing group.Patients with iatrogenic ASD were followed up for 3 months,1 case had lacunar cerebral infarction and 2 cases had migraine.The incidence of persistent atrial fibrillation and international normalized ratio in iatrogenic ASD group was higher than that in normal healing group(P<0.05),and the left atrial diameter was larger than that in normal healing group(P<0.05).Logistic regression analyze showed that left atrial diameter>38 mm was an independent risk factor for iatrogenic ASD(OR=1.119,95%CI:1.006-1.245,P=0.038).Conclusion Iatrogenic ASD is frequent after radiofrequency ablation of atrial fibrillation.The increase of left atrial diameter is an independent risk factor for iatrogenic ASD.Iatrogenic ASD can still lead to clinical events,which should be paid more attention.

关 键 词：心房颤动 房间隔穿刺术 医源性房间隔缺损 导管消融 

分 类 号：R541.75[医药卫生—心血管疾病]