经射频导管消融术治疗的心律失常患者并发心脏压塞的原因、治疗及预后  

Causes,Treatment,and Prognosis of Cardiac Tamponade in Patients with Arrhythmia Treated by Radiofrequency Catheter Ablation

作　　者：李陶宇 杨少华 胥良[1] 赵育洁 LI Taoyu;YANG Shaohua;XU Liang;ZHAO Yujie(Department of Cardiology,the Seventh People’s Hospital of Zhengzhou,Zhengzhou 450052,China)

机构地区：[1]郑州市第七人民医院心血管内科河南省心律失常医学重点实验室,河南郑州450052

出　　处：《河南医学研究》2025年第8期1357-1361,共5页Henan Medical Research

基　　金：河南省2022年科技发展计划(222102310667);2021年郑州市名医支持项目;2022年度郑州市科技惠民计划项目(2022KJHM0033)。

摘　　要：目的 对经射频导管消融术治疗的心律失常患者并发急性心脏压塞(ACT)及迟发性心脏压塞(DCT)的原因、治疗及预后进行分析,为后续高危患者的识别及并发症的预防做出启示。方法 回顾分析郑州市第七人民医院于2017年1月至2021年12月接受射频导管消融术的心律失常患者的一般临床资料,对发生手术相关心脏压塞的患者按不同类型的心律失常进行分组。分析各组患者间心脏压塞的发生机制、诊疗情况及预后转归情况,并对比分析ACT及DCT患者手术中及术后的临床资料。结果 5445例射频导管消融术患者共发生心脏压塞57例(1.05%),其中3029例房性心律失常患者36例(1.19%)发生手术相关的心脏压塞,1446例阵发性室上性心动过速患者3例(0.21%)发生手术相关的心脏压塞,971例室性心律失常患者18例(1.85%)发生手术相关的心脏压塞,需要紧急外科手术的共7例。心脏压塞患者较未发生心脏压塞的患者平均年龄大(P<0.001);房性心律失常经射频导管消融术的患者相较于阵发性室上性心动过速的患者更易出现心脏压塞(P<0.05)。各组心脏压塞患者间体重指数、术中引流量、急诊外科手术、消融成功率、置管时间、止血药物应用、急诊输血、监护室住院时间及总住院时长的差异无统计学意义(P>0.05)。表现为DCT的患者共11例(0.2%),中位发病时间为术后5 h,阵发性室上性心动过速组更易表现为DCT(P<0.05)。结论 各类心律失常射频导管消融术并发心脏压塞的发生率不同,但总体发生率较低,病因、转归相似,多与导管操作不当有关,及时抢救预后一般良好,应同样重视术后DCT的发生。Objective To analyze the causes,treatment,and prognosis of acute cardiac tamponade(ACT)and delayed cardiac tamponade(DCT)in patients with arrhythmia treated with radiofrequency Catheter ablation,and provide insights for identifying high-risk patients and preventing complications in the future.Methods A retrospective analysis was conducted on the general clinical data of arrhythmia patients who underwent catheter radiofrequency ablation at the Seventh People’s Hospital of Zhengzhou from January 2017 to December 2021.Patients with surgical related pericardial tamponade were grouped according to different types of arrhythmia.The occurrence mechanism,diagnosis and treatment status,and prognosis of pericardial tamponade among different groups of patients were analyzed,and clinical data of ACT and DCT patients during and after surgery were compared and analyzed.Results Among 5445 patients undergoing catheter radiofrequency ablation,a total of 57 cases(1.05%)experienced pericardial tamponade,including 3029 cases of atrial arrhythmia,36 cases(1.19%)of surgery related pericardial tamponade,1446 cases of paroxysmal supraventricular tachycardia,3 cases(0.21%)of surgery related pericardial tamponade,971 cases of ventricular arrhythmia,18 cases(1.85%)of surgery related pericardial tamponade,and a total of 7 cases requiring emergency surgical intervention.The average age of patients with pericardial tamponade was older than that of patients without pericardial tamponade(P<0.001),radiofrequency ablation for atrial arrhythmia was more prone to pericardial tamponade compared to paroxysmal supraventricular tachycardia(P<0.05).There was no statistically significant difference in body mass index,intraoperative drainage volume,emergency surgical procedures,ablation success rate,catheterization time,hemostatic drug use,emergency blood transfusion,length of stay in the intensive care unit,and total length of stay among the groups of patients with pericardial tamponade(P>0.05).A total of 11 patients(0.2%)presented with DCT,with a medi

关 键 词：心律失常 心脏压塞 射频导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]