导管射频消融治疗老年心房颤动患者术中抗凝方案研究  

Anticoagulation protocols during catheter ablation for atrial fibrillation in the elderly

作　　者：李世兴 李健[1] 张闯[1] 赵桐 辛倩[1] 时向民[1] Li Shixing;Li Jian;Zhang Chuang;Zhao Tong;Xin Qian;Shi Xiangmin(Department of Cardiology,Sizth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;不详)

机构地区：[1]解放军总医院第六医学中心心血管病医学部,北京100048 [2]河西学院附属张掖人民医院

出　　处：《中华老年心脑血管病杂志》2025年第1期9-12,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：全军保健专项课题(18BJZ40)。

摘　　要：目的总结本中心导管射频消融治疗老年心房颤动患者术中抗凝方案研究的结果。方法回顾性入选2021年1月至2023年12月于解放军总医院第一、第六医学中心单术者组接受导管射频消融治疗的老年心房颤动患者197例,完善相关检查。采取围术期不间断抗凝方式,根据应用不同直接口服抗凝剂分为达比加群组(125例)和利伐沙班组(72例),术中根据初始活化凝血时间(activated clotting time,ACT)值应用自制公式给予相应剂量普通肝素,记录ACT达标时间和达标率,观察围术期出凝血相关不良反应。结果2组患者年龄、性别、体质量指数、既往病史、CHA_(2)DS_(2)-VASc评分、HAS-BLED评分及左心房前后径等基线资料比较,差异无统计学意义(P>0.05)。达比加群组ACT基础值明显低于利伐沙班组[(149.73±23.52)s vs(157.91±24.58)s,P=0.032],达比加群组首剂肝素量明显高于利伐沙班组[(0.71±0.12)mg/kg vs(0.65±0.13)mg/kg,P=0.031],达比加群组15min ACT达标率明显低于利伐沙班组(60%vs 74%,P<0.05),继续按公式补充肝素后达比加群组与利伐沙班组45min ACT达标率比较无显著差异(86%vs 88%,P>0.05)。达比加群组术中肝素总量明显高于利伐沙班组[(0.99±0.30)mg/kg vs(0.85±0.31)mg/kg,P=0.009]。利伐沙班组1例心包积液,达比加群组1例术后次日股静脉穿刺部位血肿,外科手术治疗,无其他严重并发症。结论老年心房颤动患者导管射频消融治疗围术期不间断抗凝,术中根据初始ACT值代入公式个体化应用普通肝素抗凝,可快速使ACT达标,提高抗凝效率。Objective To summarize the results of different perioperative anticoagulation protocols for elderly patients with atrial fibrillation(AF)undergoing catheter radiofrequency ablation in our center.Methods A total of 197elderly AF patients undergoing catheter radiofrequency ablation by a single operator in the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2021to December 2023were retrospectively recruited,and the results of relevant examinations were collected.Based on the use of different direct oral anticoagulants,they were divided into dabigatran(n=125)and rivaroxaban(n=72)groups.During the procedure,the appropriate dose of unfractionated heparin was administered according to the initial activated clotting time(ACT)with a self-made formula.The time and rate of ACT were recorded,and perioperative adverse reactions such as bleeding and thrombosis were observed.Results There were no statistical differences between the two groups in baseline data,including age,gender,BMI,medical history,CHA_(2)DS_(2)-VASc score,HAS-BLED score,and left atrial anteroposterior diameter(P>0.05).The baseline ACT value was obviously shorter(149.73±23.52svs 157.91±24.58s,P=0.032),the initial heparin dose was significantly higher(0.71±0.12mg/kg vs 0.65±0.13mg/kg,P=0.031),and the rate of ACT reaching the target within 15min was notably lower(60%vs 74%,P<0.05)in the dabigatran group than the rivaroxaban group.But no significant difference was observed in the rate of ACT reaching the target in 45min after additional heparin administration according to the formula(86%vs 88%,P>0.05).The dabigatran group used higher dose of heparin during the procedure than the rivaroxaban group(0.99±0.30mg/kg vs 0.85±0.31mg/kg,P=0.009).Pericardial effusion was observed in one patient of the rivaroxaban group,and hematoma at the site of femoral vein puncture was seen in one patients of the dabigatran group in 1dafter procedure,which was treated surgically.No other severe complications occurred.Conclusion For elderly patients wi

关 键 词：心房颤动 导管消融术 抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]