在局部麻醉下行改良房间隔穿刺技术指导左心耳封堵器植入的研究

发布时间：2018-02-02 11:05

本文关键词： 心房颤动左心耳封堵术麻醉局部　出处：《中国循环杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的:探讨局部麻醉和冠状静脉窦辅助定位的改良房间隔穿刺技术指导下行左心耳封堵术的安全性和有效性。方法:16例非瓣膜性心房颤动(房颤)患者,男性12例,平均年龄(71.0±6.0)岁,CHA_2DS_2-VASc评分为(4.1±1.5)分,均为华法林治疗禁忌证或华法林相关不良反应者,于局部麻醉下行经皮LAmbre或Amplatzer Cardiac Plug左心耳封堵器植入,均应用冠状静脉窦导管作为解剖标志完成房间隔穿刺。结果:16例患者均顺利完成房间隔穿刺,无穿刺相关并发症发生。15例(94%)患者左心耳封堵成功,1例患者因左心耳解剖结构特殊放弃封堵。平均手术时间为(65.0±23.0)min,X线曝光时间(12.0±3.0)min。植入封堵器的固定盘平均直径(32.5±6.0)mm。结论:局部麻醉下,以冠状静脉窦导管作为解剖标志指导房间隔穿刺行左心耳封堵术总体而言安全、有效。
[Abstract]:Objective: to investigate the safety and efficacy of local anesthesia and modified atrial septal puncture technique for coronary sinus assisted atrial septal occlusion. Methods: sixteen patients with non-valvular atrial fibrillation (AF) were treated with atrial atrial fibrillation (AF). The mean age of 12 males was 71.0 卤6.0 years old. The score of 2DS2-VASc was 4.1 卤1.5. Patients with contraindications of warfarin treatment or warfarin related adverse reactions were implanted with LAmbre or Amplatzer Cardiac Plug occluder under local anesthesia. Coronary sinus catheter was used as anatomic marker to complete atrial septal puncture. There were no complications associated with puncture. 15 patients with left atrial appendage were successfully occluded. One patient gave up the occlusion because of the anatomic structure of the left atrial appendage. The average operative time was 65.0 卤23.0min. X-ray exposure time was 12.0 卤3.0 min. The average diameter of the fixed disc implanted with occluder was 32.5 卤6.0 mm 路m2.Conclusion: under local anesthesia. Coronary sinus catheter was used as anatomic marker to guide atrial septal puncture for the closure of left atrial appendage.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心;
【基金】：国家自然科学基金(81600275)
【分类号】：R541.75
【正文快照】： 左心耳封堵是预防非瓣膜性心房颤动(房颤)全因死亡率[2,3]。然而,以往研究中大多采用全身麻患者缺血性卒中的重要治疗手段之一[1]。已有多个醉及心腔内超声指导下完成房间隔穿刺及左心耳封临床试验结果证实,经皮左心耳封堵术能有效预防堵,术中需要气管插管,术后需要在监护室进

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