经外周或左房肝素给药途径对左心耳封堵术中ACT监测的影响  

Effect of peripheral or intra-left atrium administration of unfractionated heparin on ACT value during left atrial appendage closure

作　　者：张彩蓝 张欣 ZHANG Cai-lan;ZHANG Xin(Department of Cardiology,Affiliated Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海200011

出　　处：《心血管康复医学杂志》2025年第1期32-36,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：上海市科学技术委员会项目(19ZR1429000)。

摘　　要：目的:探讨左心耳封堵术中不同普通肝素给药途径对活化凝血时间(ACT)及血栓形成事件的影响。方法:回顾性分析2020年8月至2021年12月期间上海交通大学医学院附属第九人民医院收治的96例房颤行左心耳封堵术患者。根据普通肝素的给药途径,患者被分为外周给药组(n=45)与左房给药组(n=51),各组肝素按照100IU/kg一次性给予,比较各组首剂肝素给药后20、40、60min ACT值及围手术期血栓形成、出血并发症情况。结果:①两组人群在年龄及性别构成,白蛋白、血小板计数、血红蛋白、估测的肾小球滤过率、术前抗凝药使用等基线资料方面均无显著差异(P均>0.05);②外周或左房给肝素,对给药后20、40、60min ACT测量值无显著影响(P均>0.05);但左房给药组首剂ACT达标率显著高于外周给药组(52.9%比31.1%,P=0.031);③与外周给药组(8.9%)相比,左房给药组(2.0%)有减少围手术期相关血栓形成的趋势,但无显著差异(P=0.287);两组在围手术期出血并发症亦无显著差异(P=1.000)。结论:左房内肝素给药能够提高首剂ACT的达标率(>250s)及减少手术过程中器械相关血栓形成的趋势。Objective:To investigate the effect of different administration routes of unfractionated heparin(UFH)during left atrial appendage closure(LAAC)on activated clotting time(ACT)values and thrombosis event.Methods:We retrospectively analyzed 96 patients with atrial fibrillation undergoing LAAC in Affiliated Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine between August 2020 and December 2021.According to administration routine of UFH,patients were divided into peripheral administration group(n=45)and left atrium administration group(n=51).Each group was given one-off 100 IU/kg UFH.ACT values at 20,40 and 60 min after first-dose UFH administration,incidence of perioperative thrombosis and bleeding were compared between two groups.Results:①There were no significant differences in baseline data,including age,gender,albumin,platelet count,hemoglobin,estimated glomerular filtration rate,preoperative anticoagulant usages etc.between two groups(P>0.05 all);②There were no significant difference in ACT values at 20,40 and 60min after administration between peripheral and left atrium administration(P>0.05 all),but first-dose ACT standard-reaching rate in left atrium administration group was significantly higher than that of peripheral administration group(52.9%vs.31.1%,P=0.031);③Left atrium administration group had lower incidence of perioperative thrombosis(2.0%vs.8.9%,P=0.287)comparing to peripheral administration group without statistical difference;there was no significant difference in incidence of perioperative bleeding between two groups(P=1.000).Conclusion:Intra-left atrium administration of unfractionated heparin could increase first-dose ACT standard-reaching rate(>250s)and might provide a trend of decreased thrombosis.

关 键 词：心房颤动 左心耳封堵术 肝素 

分 类 号：R541.74[医药卫生—心血管疾病]