左心耳封堵术中使用新型"钢珠法"和传统"鞘管法"测量左心耳结果对比分析  

Comparative analysis of left atrial appendage measurement using new"steel ball method"and traditional"sheath method"in left atrial appendage occlusion

作　　者：金河 何斌[1] 杜先锋[1] 王彬浩 丰明俊[1] 郁一波[1] 刘晶[1] 傅国华[1] 周旭艳 王航轩 储慧民[1] Jin He;He Bin;Du Xianfeng;Wang Binhao;Feng Mingjun;Yu Yibo;Liu Jing;Fu Guohua;Zhou Xuyan;Wang Hangxuan;Chu Huimin(Arrhythmia Center,Ningbo First Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第一医院心律失常诊疗中心,宁波315000

出　　处：《中华心律失常学杂志》2022年第2期171-175,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：宁波市科学技术局科技惠民项目(2016C51011)。

摘　　要：目的在经导管左心耳封堵术中,分别使用新型"钢珠法"和传统"鞘管法"测量左心耳尺寸,并对结果进行对比分析。方法回顾性分析2018年1月至2018年12月在宁波市第一医院心律失常诊疗中心成功完成经导管左心耳封堵术的心房颤动(房颤)患者74例。其中,男50例、女24例,中位年龄70(47~87)岁。传统"鞘管法"分别使用12 F输送鞘和5 F猪尾导管作为参考标尺,而新型"钢珠法"使用直径10 mm钢珠(固定于患者体表胸骨左缘第3肋间)作为参考标尺,统一在右前斜位(RAO)30°+足位(CAU)20°X线投射体位下推注造影剂进行造影显像,并分别测量左心耳开口宽度、左心耳深度及封堵器的标记环长度。结果共74例入组患者,其中持续性房颤57例,CHA2DS2-VASc评分为(4.65±1.54)分、HAS-BLED评分为(3.35±1.08)分。钢珠组测量的左心耳平均开口宽度(24.78±3.26)mm,显著高于输送鞘组(19.88±3.25)mm和猪尾导管组(22.36±3.81)mm(P<0.001);钢珠组测量的标记环长度(20.75±0.60)mm,其与真实标记环长度21 mm差值[(0.25±0.60)mm]显著小于输送鞘组[(4.34±1.74)mm]和猪尾导管组[(2.29±1.83)mm,P<0.001]。最终以钢珠法测量值为标准来选择封堵器大小,植入成功率98.7%(74/75,1例因左心耳开口太大放弃封堵)。所有患者术后45 d随访经食管超声心动图(TEE)检查未发现封堵器相关血栓形成及其他手术相关并发症。结论在经导管左心耳封堵术中,使用新型"钢珠法"进行左心耳大小测量是准确且安全有效的。若以传统"鞘管法"测量结果来选择封堵器大小,很有可能导致选择的封堵器尺寸偏小而影响手术结果。Objective To compare the left atrial appendage(LAA)measurement using the new"steel ball method"and the traditional"sheath method"in left atrial appendage occlusion(LAAO).Methods Patients with atrial fibrillation(AF)who underwent LAAO of WATCHMAN were included in Arrhythmia Center,Ningbo First Hospital from January 2018 to December 2018 delivery sheath,5 F pigtail catheter and 10 mm diameter steel ball were used to measure the width/depth of LAA and length of WATCHMAN Marker with RAO 30°+CAU 20°X view on fluoroscopy.Results A total of 74 patients were consecutively selected.The CHA2DS2-VASc was 4.65±1.54,and the HAS-BLED was 3.35±1.08.The mean width of LAA measured in the steel ball group was(24.78±3.26)mm,which was significantly higher than(19.88±3.25)mm in the delivery sheath group and(22.36±3.81)mm in the pigtail catheter group(P<0.001).The difference[(0.25±0.60)mm]between the actual length of WATCHMAN marker(21 mm)and the length measured in the steel ball group was significantly smaller than that of the delivery sheath group[(4.34±1.74)mm]and the pigtail catheter group[(2.29±1.83)mm,P<0.001].The size of WATCHMAN was eventually selected based on the measurement in steel ball group,and the success rate of implantation was 98.7%(74/75,1 gave up occlusion due to too large width of LAA).No device-related thrombosis or other complications was found in transesophageal echocardiography 45 days post-procedure.Conclusion In LAAO,using the new"steel ball method"to measure LAA is accurate and safe.The size of the occluder will be too small if based on the measurement of traditional"sheath method",which may probably affect the out comeofprocedure.

关 键 词：心房颤动 左心耳封堵 钢珠 鞘管 

分 类 号：R541.75[医药卫生—心血管疾病]