数字减影血管造影指导下极简式经皮左心耳封堵术治疗非瓣膜病心房颤动35例  

Nonvalvular atrial fibrillation in percutaneous left atrial appendage occlusion guided by DSA:35 cases

作　　者：章雯[1] 何非[2] 丁旵东[1] ZHANG Wen;HE Fei;DING Chandong(Department of Geriatric Cardiovascular Medicine,The Sec-ond Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China;Department of Cardiovascular Medicine,The Sec-ond Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院老年心血管内科,安徽合肥230601 [2]安徽医科大学第二附属医院心血管内科,安徽合肥230601

出　　处：《安徽医药》2022年第5期1023-1027,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨无全身麻醉、无经食管超声心动图(TEE)的在数字减影血管造影(DSA)指导下极简式经皮左心耳封堵术(PLAAO)治疗非瓣膜病心房颤动的可行性及安全性。方法选取2019年9月至2020年12月安徽医科大学第二附属医院收治的具有手术指征的非瓣膜病心房颤动病人35例,术中左心耳造影替代TEE、局部麻醉下进行PLAAO;并于术后45 d、6个月复查TEE,观察PLAAO相关主要不良事件。结果32例术中器械操作成功,1例因左心耳开口过大无合适大小封堵器,1例因导管同轴性不佳不能调至可释放位置,1例术中出现低血压不能纠正,未能完成手术。除1例出现锁骨下穿刺点血肿外,其他病人无封堵相关严重并发症,住院及随访期间无PLAAO相关主要不良事件发生。手术时间及X线透视时间分别为(50.27±24.60)min及(11.09±5.72)min。住院天数(4.25±1.36)d,手术费用(不含麻醉及封堵器费用)(19648.04±1838.45)元。结论DSA指导下极简式PLAAO治疗非瓣膜病心房颤动是安全有效的,该方法简化了手术方式、降低手术费用,减少住院时间,减少不良反应,有利于PLAAO手术常态化开展及推广。Objective To investigate the feasibility and safety of percutaneous left atrial appendage closure(PLAAO)guided by dig⁃ital subtraction angiography(DSA)without general anesthesia and transesophageal echocardiography(TEE).Methods Thirty-five pa⁃tients with non-valvular atrial fibrillation who met the surgical criteria in the Second Affiliated Hospital of Anhui Medical University from September 2019 to December 2020 were selected.Intraoperative left atrial appendage angiography replaced TEE and PLAAO was performed under local anesthesia.TEE was reexamined at 45 days and 6 months after operation to observe the main adverse events re⁃lated to PLAAO.Results Intraoperative device operation was successful in 32 patients,1 patient had no appropriate size occluder due to too large left atrial appendage opening,1 patient could not be adjusted to the releasable position due to poor catheter coaxiality,and 1 patient had low intraoperative blood pressure which is difficult to correct and could not complete the operation.One patient had sub⁃clavian puncture site hematoma,no serious complications related to occlusion were found in the other patients,and no major adverse events related to PLAAO occurred during hospitalization and follow-up.The operation time and fluoroscopy time were(50.27±24.60)min and(11.09±5.72)min.The hospital stay was(4.25±1.36)days,and the operation cost(excluding anesthesia and occluder cost)of PLAAO patients under minimalist local anesthesia in this group were(19648.04±1838.45)yuan,respectively.Conclusions Minimal⁃ist PLAAO under the guidance of DSA is safe and effective in the treatment of non-valvular atrial fibrillation.This method simplifies the surgical process,reduces the cost of surgery,reduces the length of hospital stay,reduces adverse reactions,which is conducive to the normalization and promotion of PLAAO operation.

关 键 词：心房颤动 经皮左心耳封堵术 经食管超声心动图 数字减影血管造影 麻醉 局部 

分 类 号：R654.2[医药卫生—外科学]