左心耳封堵术后发生心包积液相关危险因素的临床分析  

Clinical analysis of risk factors of pericardial effusion after transcatheter closure of left atrial appendage

作　　者：周明瑶 张莎 张竞予 吕桐巍 陈科宇 白元 郭志福 ZHOU Ming-yao;ZHANG Sha;ZHANG Jing-yu;LYU Tong-wei;CHEN Ke-yu;BAI Yuan;GUO Zhi-fu(Department of Cardiology The First Affiliated Hospital of the People’s Liberation Naval Medical University,Shanghai 200433,China)

机构地区：[1]中国人民解放军海军军医大学第一附属医院心血管内科,上海市200433

出　　处：《中国心血管病研究》2024年第10期889-894,共6页Chinese Journal of Cardiovascular Research

基　　金：上海市卫生健康委员会科研项目(20224Z0007)。

摘　　要：目的探讨左心耳封堵术(left atrial appendage closure,LAAC)后心包积液(pericardial effusion,PEF)的发生率、治疗方法和危险因素。方法本研究为回顾性研究,共纳入2016年6月至2022年12月期间在中国人民解放军海军军医大学第一附属医院心血管内科因心房颤动(房颤)接受LAAC的患者502例。根据LAAC后是否发生PEF,将患者分为PEF组和非PEF组。运用Cox比例风险回归模型探讨PEF的危险因素。结果LAAC后发生PEF共17例,其中13例需要经皮心包穿刺术或外科手术干预,所有患者在25.6个月的随访中均完全康复。与非PEF组相比,PEF组封堵器尺寸较小[(23.8±4.4)mm比(27.3±4.3)mm,P=0.009],住院时间延长[(6.8±7.9)d比(19.3±14.9)d,P<0.0001]。多变量分析表明,阵发性房颤(OR=4.578,95%CI 1.102~19.024;P=0.036)、既往大出血病史(OR=4.969,95%CI 1.150~21.470;P=0.032)以及术者经验不足(OR=6.036,95%CI 1.915~19.028;P=0.002)是PEF发生的独立危险因素。结论PEF是LAAC后常见的并发症,阵发性房颤、既往大出血病史和经验不足的术者会增加PEF的发生风险,同时封堵器的尺寸也与PEF的发生相关。Objective To investigate the incidence,treatment methods and risk factors of pericardial effusion(PEF)after left atrial appendage closure(LAAC).Methods 502 patients with atrial fibrillation who underwent LAAC at First Affiliated Hospital of Naval Medical University from June 2016 to December 2022 were included.The patients were divided into the PEF group and the non-PEF group based on whether they developed pericardial effusion after LAAC.The Cox proportional hazards regression model was used to explore the risk factors for pericardial effusion.Results A total of 17 cases of PEF occurred after LAAC,with 13 cases requiring percutaneous pericardiocentesis or surgical intervention.All the patients fully recovered during the 25.6-month follow-up period.Compared with the non-PEF group,the patients in the pericardial effusion group had smaller occluder sizes[(23.8±4.4)mm vs.(27.3±4.3)mm,P=0.009]and longer hospital stays[(6.8±7.9)d vs.(19.3±14.9)d,P<0.0001].Multivariate analysis indicated that paroxysmal atrial fibrillation(OR=4.578,95%CI 1.102-19.024;P=0.036),a history of major bleeding(OR=4.969,95%CI 1.150-21.470;P=0.032)and lack of operating experience(OR=6.036,95%CI 1.915-19.028;P=0.002)were the independent risk factors for PEF.Conclusion PEF is a common complication after LAAC.Paroxysmal atrial fibrillation,a history of major bleeding and inexperienced operators increase the risk of pericardial effusion.The size of the occluder is also associated with the occurrence of PEF.

关 键 词：心包积液 左心耳封堵 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病]