经皮左心耳封堵术的单中心学习曲线评价  

Evaluation of the single center learning curve for percutaneous left atrial appendage closure

作　　者：陈韬[1] 刘阁 王清松 穆洋[1] 朱航[1] 韩宝石[1] 汪奇[1] 郭军[1] 陈韵岱[1] Chen Tao;Liu Ge;Wang QingSong;Mu Yang;Zhu Hang;Han Baoshi;Wang Qi;Guo Jun;Chen Yundai(Department of Cardiovascular,Chinese PLA General Hospital,Beijing 100853,China;不详)

机构地区：[1]中国人民解放军总医院心血管病医学部,北京100853

出　　处：《中国循证心血管医学杂志》2021年第10期1174-1178,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家重点研发计划(2018YFC2001205);北京市科技新星计划(Z181100006218120);军队青年人才托举工程(17-JCJQ-QT-029)。

摘　　要：目的评估单中心单一术者使用WATCHMAN封堵器行左心耳封堵术学习曲线的影响。方法连续选入2015年12月至2018年11月于中国人民解放军总医院使用WATCHMAN封堵器行经皮左心耳封堵术患者90例。根据行经皮左心耳封堵手术时间分为:第1~30例纳入A组;第31~60例纳入B组;第61~90例纳入C组。分别对三组患者的临床基本资料、选择手术操作时间、透视时间、放射剂量、单位面积的射线剂量(DAP)、对比剂用量和围手术期不良事件等相关参数进行分析。结果所有患者均为高卒中风险合并高出血风险的心房纤颤患者,平均CHA2DS2-VASc评分为5.2±1.4分,HAS-BLED评分为3.6±1.1分。A组、B组、C组的左心耳封堵平均操作时间分别为(68±27)min、(46±18)min、(36±7)min(P<0.001);封堵过程中透视时间分别为(15±4)min、(10±5)min、(10±3)min(P<0.001),放射剂量分别为(780±587)mGy、(396±461)mGy、(339±108)mGy,DAP分别为(66±49)Gy·cm^(2)、(33±39)Gy·cm^(2)、(29±9)Gy·cm^(2),造影剂剂量分别为(88±21)ml、(66±13)ml、(64±13)ml(P均<0.001)。手术成功率为97.7%,麻醉方式由全身麻醉逐步过渡至基础麻醉,三组患者围手术期不良事件的发生率呈进一步减少的趋势(26.7%vs.20.0%vs.6.7%,P=0.186)。结论随着术者手术经验的增多,使用WATCHMAN封堵左心耳的手术时间、射线量与造影剂使用剂量进一步下降,不良事件呈进一步下降趋势。Objective To evaluate the effect of the learning curve in a single center cohort of patients undergoing left atrial appendage closure with the watchman occluder.Methods From December 2015 to November 2018,90 patients underwent percutaneous left atrial appendage occlusion with watchman occluder in the General Hospital of the Chinese people's Liberation Army.According to the operation time of percutaneous left atrial appendage occlusion,the patients were divided into group A(1st-30th cases),group B(31st-60th cases),group C(61st-90th cases).The clinical data,operation time,fluoroscopy time,radiation dose,dose area product(DAP),contrast agent dosage and perioperative adverse events of the three groups were analyzed.Results The mean age of all patients was 70.1±9.6 years,the mean CHA2DS2-VASc score was 5.2±1.4,and the mean HAS-BLED score was 3.6±1.1.The success rate was 97.7%.The mean procedure time was 68±27 min versus 46±18 min versus 36±7 min(P<0.001).The X-ray fluoroscopy time was 15±4 min versus 10±5min versus 10±3 min,the radiation dose was 780±587 mGy versus 396±461 mGy versus 339±108 mGy,the Dose Area Product(DAP)was 66±49 Gy·cm^(2) versus 33±39 Gy·cm^(2) versus 29±9 Gy·cm^(2),and the contrast agent dose was 88±21 ml versus 66±13 ml to 64±13 ml(P<0.001,respectively).The type of anesthesia was gradually transferred from general anesthesia to basal anesthesia,and the incidence of perioperative adverse events was gradually reduced(26.7%vs.20.0%vs.6.7%,P=0.186).Conclusion With the increasing of procedure experience,the operation time,radiation dose and contrast dose of percutaneous left atrial appendage closure with WATCHMAN device were decreased further,and the adverse events showed a further decline.

关 键 词：左心耳封堵 左心耳 学习曲线 

分 类 号：R318.11[医药卫生—生物医学工程]