LAmbre左心耳封堵术应用于非瓣膜性心房颤动患者的临床疗效评估  

Clinical effect of LAmbre left atrial appendage closure in patients with nonvalvular atrial fibrillation

作　　者：刘春霞[1] 熊峰[1] 邓晓奇[1] 王淑珍[1] 张丽娟[1] 徐敏[1] 黄晓凤 雷亚莉 LIU Chun-xia;XIONG Feng;DENG Xiao-qi;WANG Shu-zhen;ZHANG Li-juan;XU Min;HUANG Xiaofeng;LEI Ya-li(Department of Cardiology,Cardiovascular Institute of Chengdu,The Third People′s Hospital of Chengdu,Chengdu 610031,China)

机构地区：[1]成都市第三人民医院成都市心血管病研究所心内科,成都610031

出　　处：《岭南心血管病杂志》2020年第4期429-434,共6页South China Journal of Cardiovascular Diseases

基　　金：四川省科技厅课题基金(项目编号:2018JY0385)。

摘　　要：目的评估应用LAmbre左心耳封堵器行左心耳封堵术(left atrial appendage closure,LAAC)的非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者术后的临床疗效。方法纳入2017年10月至2018年11月成都市第三人民医院行LAAC的NVAF患者16例,随访患者住院期间至术后6个月内并发症及不良事件情况,应用经胸超声心动图和食道超声心动图随访术前及术后相关参数的变化。结果16例接受LAAC的NVAF患者CHA2DS2-VASc评分为(3.46±1.90)分,HAS-BLED评分为(3.00±0.71)分;左心耳开口径为(21.62±1.61)mm,左心耳锚定区直径为(20.85±1.46)mm,置入封堵器(固定伞)直径为(24.92±1.55)mm。16例患者封堵均获得成功,围术期均未出现空气栓塞、心包积液、心包填塞、介入相关出血事件。术后6个月随访期间,1例患者发生脑卒中事件(左侧大脑中动脉闭塞),余无重要脏器出血事件、心血管死亡或其他不明原因死亡发生;术后1个月、术后3个月、术后6个月患者的左心房内径、左心房面积、左心房容积、左心室内径、左心室射血分数、E、e′、E/e′、纽约心脏协会心功能分级与术前比较,均差异无统计学意义(P>0.05);患者术后1个月、术后3个月、术后6个月上述参数比较,差异无统计学意义(P>0.05)。结论应用LAmbre封堵器封堵左心耳,可作为NVAF患者预防相关血栓栓塞并发症的新方法,术后临床疗效好,安全性高,并发症少。Objectives To evaluate the clinical efficacy of LAmbre left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF).Methods A retrospective study was performed in 16 NVAF patients underwent LAAC from October 2017 to November 2018 in The Third People’s Hospital of Chengdu.Complications and major cardiovascular events were followed up from hospitalization to 6 months after surgery.Transthoracic echocardiography and transesophageal echocardiography were used to observe preoperative and postoperative changes of related parameters.Results CHA2 DS2-VASc score and HAS-BLED score in 16 NVAF patients underwent LAAC were 3.46±1.90 and3.00±0.71,respectively.The opening diameter and the anchor area of left atrial appendage were(21.62±1.61)mm and(20.85±1.46)mm,respectively.The diameter of the LAmbre sealing device(umbrella)was(24.92±1.55)mm.All the patients were successfully closed after LAAC.None patient had air embolism,pericardial effusion,pericardial tamponade and interventional bleeding event during perioperative stage.During the follow-up of 6 months,one patient had a stroke event(left middle cerebral artery occlusion),no major organ hemorrhage,cardiovascular death or other unexplained death occurred.There were no significant differences in the left atrial diameter,left atrial area,left atrial volume,left ventricular diameter,left ventricular ejection fraction,E,e’,E/e’and New York Heart Association(NYHA)heart function grade of patients between 1 month,3 months and 6 months after LAAC with pre-operation,and no significant differences in the above parameters among the patients in 1 month,3 months and 6 months after LA AC.Conclusions LAmbre LAAC has good efficacy,high safety and less complication,which can be used as a new method to prevent embolization complication in patients with NVAF.

关 键 词：心房颤动 左心耳 左心耳封堵术 LAmbre 超声心动图 疗效 

分 类 号：R541.7[医药卫生—心血管疾病]