老年人心房颤动导管射频消融并发心脏压塞的临床分析  

Clinical analysis of cardiac tamponade complicating radiofrequency ablation of atrial fibrillation in elderly patients

作　　者：阮燕菲[1] 赵倩倩 李林凌 张梦夏 刘念[1] 董建增[1] 马长生[1] Ruan Yanfei;Zhao Qianqian;Li Linling;Zhang Mengxia;Liu Nian;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华老年医学杂志》2021年第2期173-177,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81530016、81670291、81770318)。

摘　　要：目的探讨年龄与房颤导管消融并发心脏压塞之间的关系。方法回顾性收集2013年1月至2016年12月在北京安贞医院行首次房颤导管射频消融术的患者,收集其围术期临床资料,分为老年组(≥60岁)和非老年组(<60岁),利用回归模型分析老年与房颤消融心脏压塞发生的关系。结果本研究共纳入患者5313例,发生心脏压塞41例(0.77%);老年组心脏压塞发生比例1.1%(32/2950),明显高于非老年组0.4%(9/2363)(χ^(2)=8.489,P=0.004)。老年组1例行急诊开胸心房修补术,而非老年组0例;无1例患者院内死亡。多因素Logistic回归分析结果显示,与非老年组患者比较,老年组发生心脏压塞发生风险增加(OR=2.570,95%CI:1.190~5.570,P=0.017);分层分析结果显示,女性、口服抗凝药物、左房内径<40 mm和手术时间≥120 min的患者中,老年组心脏压塞发生风险较非老年组更高(OR=1.011、2.914、3.922、3.244,均P<0.05)。结论老年(年龄≥60岁)是房颤导管消融发生心脏压塞的独立危险因素。Objective To investigate the association between age and cardiac tamponade after radiofrequency ablation of atrial fibrillation(RAAF).Methods Clinical data of patients undergone de novo AF ablation procedures at Beijing Anzhen Hospital from January 2013 to December 2016 were retrospectively collected.Patients were divided into an elderly group(age≥60 years)and a non-elderly group(age<60 years).Logistic regression analyses were used to evaluate the association between old age and the risk of cardiac tamponade complicating RAAF.Results A total of 5313 patients were involved in this study,including 41 patients(0.77%)with cardiac tamponade.The proportion of cardiac tamponade was higher in the elderly group than in the non-elderly group(1.1%or 32/2950 vs.0.4%or 9/2363,χ2=8.489,P=0.004).One patient with cardiac tamponade in the elderly group required immediate surgical repair whereas none in the non-elderly group did.No patient died in hospital.Multivariate Logistic regression analysis showed that the risk of cardiac tamponade increased in the elderly group,compared with the non-elderly group(OR=2.570,95%CI:1.190-5.570,P=0.017).Stratified analysis revealed that among females and patients with oral anticoagulants,left atrium dimension<40 mm or procedure duration≥120 min in the elderly group carried a higher risk of cardiac tamponade than those in the non-elderly group(OR=1.011,2.914,3.922 and 3.244,P<0.05).Conclusions Old age(age≥60 years)is an independent risk factor for cardiac tamponade complicating RAAF.

关 键 词：心房颤动 导管消融术 心脏压塞 

分 类 号：R541.75[医药卫生—心血管疾病]