导管消融联合左心耳封堵术治疗房颤的研究

发布时间：2018-04-02 17:26

本文选题：房颤　切入点：导管消融　出处：《浙江大学》2016年硕士论文

【摘要】：目的：对于非瓣膜性房颤患者,左心耳是90%血栓的来源位置。导管消融是一种可以有效治疗症状性房颤的手术,同时左心耳封堵术是一种能有效预防房颤患者发生脑卒中的手术。而在单次手术手术中同时进行导管消融和左心耳封堵术的安全性和可行性尚且不明确。方法：对26例在我院诊断为非瓣膜性房颤、符合条件的患者进行导管消融联合左心耳封堵手术。导管消融采用肺静脉电位隔离术,左心耳封堵采用Watchman封堵器植入术。结果：本次研究共入选26例患者(其中女性10例),患者平均年龄为64±10岁(范围为46-83岁),CHA2DS2-VASc评分的平均分为3.5±1.6分(范围为2-7分),HAS-BLED评分的平均分为2.4±1.1分(范围为1-5分)。其中有11例(42%)患者有脑梗死的病史。所有的病人均成功完成联合手术(100%)。手术的平均时间为162.8±61.2分(范围为52-284分)。术后所有病人的左心耳都达到了封堵标准,完全封堵的有22例(84.6%)。术后3月有4例新发的封堵伞周残余漏,但是仍然在封堵标准之内。围手术期并发症主要有2例患者有心包积液。手术后左心房的结构没有产生显著改变(4.3cm vs 4.3cm, p 0.05),但是患者的射血分数有明显的提升(60.4%vs 66.9%,p0.05)。随访中没有出现死亡、脑卒中、心包积液、出血、器械栓塞等并发症。有1例患者半年后房颤复发。结论：一次性完成导管消融联合左心耳封堵手术对于中国非瓣膜性房颤患者是可行的,安全的,有效的。这可以作为药物难治疗的症状性房颤患者,高脑卒中风险房颤患者和对口服抗凝药有相对或者绝对禁忌症患者的治疗方案。
[Abstract]:Objective: in patients with non-valvular atrial fibrillation, the left atrial appendage is the source of 90% thrombus.Catheter ablation is an effective procedure for the treatment of symptomatic atrial fibrillation and left atrial appendage occlusion is an effective procedure to prevent stroke in patients with atrial fibrillation.However, the safety and feasibility of simultaneous catheter ablation and left atrial appendage closure in a single operation are unclear.Methods: 26 patients with non-valvular atrial fibrillation who were diagnosed as non-valvular atrial fibrillation were treated with catheter ablation combined with left atrial appendage closure.Catheter ablation was performed with pulmonary vein potential isolation and left atrial appendage occlusion with Watchman occluder.Among them, 11 cases had a history of cerebral infarction.All the patients successfully completed the combined operation.The mean operation time was 162.8 卤61.2 minutes (range: 52-284 minutes).The left atrial appendage of all the patients reached the standard of occlusion after operation, and 22 patients were completely occluded (84.6%).Three months after operation, 4 cases had residual leakage around the occluder, but it was still within the standard of occlusion.Pericardial effusion was found in 2 patients with perioperative complications.There was no significant change in the structure of the left atrium after operation (4.3 cm vs 4.3 cm, p 0.05), but the ejection fraction of the patients was significantly improved by 60.4 cm vs 66.9 cm.No complications such as death, stroke, pericardial effusion, hemorrhage, instrumentation embolism were observed during follow-up.One patient recurred after half a year of atrial fibrillation.Conclusion: one-time catheter ablation combined with left atrial appendage closure is feasible, safe and effective for patients with non-valvular atrial fibrillation in China.This can be used as a treatment regimen for symptomatic atrial fibrillation patients with refractory drugs, patients with high stroke risk atrial fibrillation and patients with relative or absolute contraindications to oral anticoagulants.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.75

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