非瓣膜性心房颤动患者“一站式”手术策略的有效性和安全性:单中心经验  

Effectiveness and Safety of“One-Step”Procedure in Patients with Non-Valvular Atrial Fibrillation:A Single Center Experience

作　　者：加依娜·加尔肯 汤宝鹏[1] 周贤惠[1] 李耀东[1] 芦颜美[1] Jiayina·Jiaerken;TANG Baopeng;ZHOU Xianhui;LI Yaodong;LU Yanmei(Department of Pacing and Electrophysiology/Department of Cardiac Electrophysiology and Remodeling,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科/新疆心电生理与心脏重塑重点实验室,新疆乌鲁木齐830054

出　　处：《心血管病学进展》2022年第12期1141-1147,共7页Advances in Cardiovascular Diseases

基　　金：国家自然科学基金(81860081)。

摘　　要：目的探讨非瓣膜性心房颤动(房颤)患者行消融联合左心耳封堵的“一站式”手术治疗的有效性和安全性。方法单中心回顾性分析,纳入2019年2月—2021年4月在新疆医科大学第一附属医院行“一站式”手术的非瓣膜性房颤患者(50例)为试验组,同期行单纯房颤消融术的非瓣膜性房颤患者(50例)为对照组,比较两组围手术期、术后3个月、6个月进行随访的房颤复发率、卒中等并发症发生率以及心脏结构和功能的改善,评价“一站式”手术的短期有效性和安全性。结果术后3个月试验组房颤复发率(18%)低于对照组(34%),两组患者血液学指标较术前均有一定程度的改善,术后6个月数据中试验组E/A值≥1的患者占比高于对照组(P<0.001)。两组患者均未发生脑卒中、空气栓塞和死亡,试验组心包积液发生率高于对照组,肺实质渗出发生率低于对照组,出血、血肿、胸腔积液和心脏压塞发生率与对照组类似。对照组围手术期发生2例下肢静脉血栓,术后3个月发生2例短暂性脑缺血发作、1例肺栓塞,术后6个月未发生血栓栓塞事件,试验组未出现血栓栓塞事件。结论对于卒中或出血高危、不耐受长期抗凝治疗的非瓣膜性房颤患者,“一站式”手术可作为一种新的安全有效的治疗策略。Objective To investigate the short-term effectiveness and safety of“one-step”surgical strategy of combining atrial fibrillation(Af)ablation with left atrial appendage occlusion(LAAO)in patients with non-valvular Af.Methods It’s a single-center retrospective analysis.A total of 50 patients underwent Af ablation and LAAO in The First Affiliated Hospital of Xinjiang Medical University from February 2019 to April 2021 were enrolled and classified into experimental group.Another 50 patients contemporarily underwent Af ablation alone were set as control group.To evaluate the short-term efficacy and safety of one-step surgery,all patients were followed up at perioperation,3 and 6 months after operation by comparing the incidence of recurrent Af,stroke and other complications as well as improvements of cardiac structure and function.Results The recurrence rate of Af was lower in experimental group(18%)than control group(34%),and postoperatively hematological indexes of two groups got partly improved.From the data of 6 months after operation,the proportion of patients with E/A≥1 was higher in experimental group than control group(P<0.001).There was no stroke,air embolism or death occurred.The incidence of pericardial effusion was higher in experimental group,the incidence of pulmonary parenchymal exudation was lower than control group,while the incidence of bleeding,hematoma,pleural effusion and cardiac tamponade were similar between two groups.In control group,2 cases of lower extremity venous thrombosis occurred during perioperation period,2 cases of transient ischemic attack and 1 case of pulmonary embolism occurred in 3 months after operation.No thromboembolic event occurred at 6 months after operation and in experimental group.Conclusion For patients with non-valvular Af at high risk of stroke or bleeding and not tolerating long-term anticoagulant therapy,“one-step”surgery may serve as a new safe and effective treatment strategy.

关 键 词：心房颤动 经导管消融术 左心耳封堵术 卒中 

分 类 号：R654.2[医药卫生—外科学]