TEE在房颤患者射频消融术前诊断左心耳血栓的应用  

Diagnostic value of TEE indexes in left atrial appendage thrombus in patients with atrial fibrillation before radiofrequency ablation

作　　者：伍明月 雷芳 阳玉晶 WU Mingyue;LEI Fang;YANG Yujing(Department of Ultrasound Diagnosis,Guilin Municipal Hospital of Traditional Chinese Medicine,Guilin 541002,China;Department of Ultralsound,The second Affiliated Hospital of Guilin Medical University,Guilin 541199,China)

机构地区：[1]广西壮族自治区桂林市中医医院超声诊断科,广西桂林541002 [2]桂林医学院第二附属医院超声科,广西桂林541199

出　　处：《医学影像学杂志》2025年第1期45-48,共4页Journal of Medical Imaging

基　　金：广西壮族自治区卫生健康委员会科技研究计划课题(编号:Z20180109)。

摘　　要：目的探讨左心耳(LAA)血栓形成的危险因素,分析经食管超声心动图(TEE)在房颤患者射频消融术前诊断LAA血栓的应用。方法选取82例持续性房颤患者作为房颤组,另选择82例疑似房颤但最终未确诊的患者作为对照组,所有患者均行经胸超声检查和TEE检查,测量并记录左心房(LA)前后径、左右径、LAA最大排空速度(LAA-FEV)和LAA最大充盈速度(LAA-FFV),测量LAA容积(LAA-V),并计算LAA射血分数(LAA-EF)。根据TEE结果,将房颤组患者分为血栓组(n=21)和无血栓组(n=61)。采用Logistic回归分析LAA血栓形成的影响因素。结果房颤组LAA前后径、左右径、心耳深度、心耳口径和LAA-V均大于对照组,差异有统计学意义(P<0.05)。房颤组LAA-FEV、LAA-FFV和LAA-EF均明显小于对照组,LAA-V明显大于对照组,差异有统计学意义(P<0.05)。TEE对房颤患者LAA血栓的检出率为25.61%。血栓组LAA-FEV、LAA-FFV和LAA-EF均明显小于无血栓组,LAA-V明显大于无血栓组,差异有统计学意义(P<0.05)。LAA-FEV降低(OR=0.480,P=0.015)、LAA-FFV降低(OR=0.359,P=0.009)、LAA-EF(OR=0.420,P=0.033)降低和LAA-V升高(OR=2.570,P=0.013)均为LAA血栓形成的危险因素(均P<0.05)。结论TEE对房颤患者LAA血栓有良好的诊断价值,射频消融术前可通过TEE评估患者LAA血栓发生风险,确保治疗安全。Objective To analyze the risk factors of left atrial appendage thrombus(LAAT),and to explore the application value of transesophageal echocardiography(TEE)in the diagnosis of LAAT in patients with atrial fibrillation before radiofrequency ablation.Methods A total of 82 patients with persistent atrial fibrillation and 82 patients without atrial fibrillation were enrolled as atrial fibrillation group and control group.All underwent transthoracic echocardiography and TEE to measure and record anteroposterior diameter and left-right diameter of left atrium,LAA flow emptying velocity(LAA-FEV),LAA flow filling velocity(LAA-FFV),left atrial appendage volume(LAA-V)and left atrial appendage ejection fraction(LAA-EF).According to TEE results,patients in atrial fibrillation group were divided into thrombus group(n=21)and non-thrombus group(n=61).The influencing factors of LAAT were analyzed by Logistics regression analysis.Results The anteroposterior diameter of left auricle,left-right diameter,auricular appendage depth,auricular appendage diameter and LAA volume in atrial fibrillation group were higher than those in control group(P<0.05).LAA-FEV,LAA-FFV and LAA-EF in atrial fibrillation group were significantly lower than those in control group,while LAA-V was significantly larger than that in control group(P<0.05).The detection rate of LAAT by TEE was 25.61%.LAA-FEV,LAA-FFV and LAA-EF in thrombus group were significantly lower than those in nonthrombus group,while LAA-V was significantly larger than that in non-thrombus group(P<0.05).The decreased LAA-FEV(OR=0.480,P=0.015),decreased LAA-FFV(OR=0.359,P=0.009),decreased LAA-EF(OR=0.420,P=0.033)and increased LAAV(OR=2.570,P=0.013)were all risk factors of LAAT(P<0.05).Conclusion TEE has good diagnostic value for LAAT in patients with atrial fibrillation.TEE can be applied to evaluate LAAT risk before radiofrequency ablation to ensure treatment safety.

关 键 词：经食管超声心动图 房颤 射频消融术 左心耳血栓 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病] R445.1[医药卫生—内科学]