中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2009年
3期
209-212
,共4页
宋洁琼%刘少稳%陈松文%周京敏%林佳雄%聂振宁%吴鸿谊%程宽%陶惠伟%葛均波
宋潔瓊%劉少穩%陳鬆文%週京敏%林佳雄%聶振寧%吳鴻誼%程寬%陶惠偉%葛均波
송길경%류소은%진송문%주경민%림가웅%섭진저%오홍의%정관%도혜위%갈균파
心血管病学%心房颤动%导管射频消融%抗凝%血栓栓塞
心血管病學%心房顫動%導管射頻消融%抗凝%血栓栓塞
심혈관병학%심방전동%도관사빈소융%항응%혈전전새
Cardiology%Atrial fibrillation%Radiofrequency catheter ablation%Anticoagulation%Throm-boembulism
目的 探讨持续性心房颤动(房颤)患者经导管射频消融术中不同抗凝方案与围术期血栓事件的关系.方法 2004年7月至2007年10月连续收治行导管射频消融治疗的持续性房颤145例.所有患者术前均口服华法林抗凝,使国际标准化比率(INR)控制在2.0～3.0至少1个月.消融前停用华法林并用低分子肝素替代抗凝.2004年7月至2006年1月消融的患者(组Ⅰ)64例,完成房间隔穿刺后,静脉给予普通肝素5000 U;2006年2月至2007年10月消融的患者(组Ⅱ)81例,完成房间隔穿刺后根据患者体重予以肝素(100 U/kg),两组患者消融术中每小时均追加肝素1000 U.消融后行低分子肝素抗凝3 d并口服华法林治疗至少3个月.结果 组Ⅰ有4例患者于围术期出现血栓形成或血栓栓塞;组Ⅱ 1例持续性房颤患者因消融后第3天自行停用华法林出现短暂性脑缺血发作,其余严格抗凝的患者均未出现血栓事件.组Ⅰ与组Ⅱ消融术前后达到抗凝要求的持续性房颤患者血栓事件发生率差异有统计学意义(4/64对0/80,P=0.037).结论 消融中根据患者体重调整抗凝强度可以显著减少持续性房颤患者围术期血栓事件并发症的发生.
目的 探討持續性心房顫動(房顫)患者經導管射頻消融術中不同抗凝方案與圍術期血栓事件的關繫.方法 2004年7月至2007年10月連續收治行導管射頻消融治療的持續性房顫145例.所有患者術前均口服華法林抗凝,使國際標準化比率(INR)控製在2.0～3.0至少1箇月.消融前停用華法林併用低分子肝素替代抗凝.2004年7月至2006年1月消融的患者(組Ⅰ)64例,完成房間隔穿刺後,靜脈給予普通肝素5000 U;2006年2月至2007年10月消融的患者(組Ⅱ)81例,完成房間隔穿刺後根據患者體重予以肝素(100 U/kg),兩組患者消融術中每小時均追加肝素1000 U.消融後行低分子肝素抗凝3 d併口服華法林治療至少3箇月.結果 組Ⅰ有4例患者于圍術期齣現血栓形成或血栓栓塞;組Ⅱ 1例持續性房顫患者因消融後第3天自行停用華法林齣現短暫性腦缺血髮作,其餘嚴格抗凝的患者均未齣現血栓事件.組Ⅰ與組Ⅱ消融術前後達到抗凝要求的持續性房顫患者血栓事件髮生率差異有統計學意義(4/64對0/80,P=0.037).結論 消融中根據患者體重調整抗凝彊度可以顯著減少持續性房顫患者圍術期血栓事件併髮癥的髮生.
목적 탐토지속성심방전동(방전)환자경도관사빈소융술중불동항응방안여위술기혈전사건적관계.방법 2004년7월지2007년10월련속수치행도관사빈소융치료적지속성방전145례.소유환자술전균구복화법림항응,사국제표준화비솔(INR)공제재2.0～3.0지소1개월.소융전정용화법림병용저분자간소체대항응.2004년7월지2006년1월소융적환자(조Ⅰ)64례,완성방간격천자후,정맥급여보통간소5000 U;2006년2월지2007년10월소융적환자(조Ⅱ)81례,완성방간격천자후근거환자체중여이간소(100 U/kg),량조환자소융술중매소시균추가간소1000 U.소융후행저분자간소항응3 d병구복화법림치료지소3개월.결과 조Ⅰ유4례환자우위술기출현혈전형성혹혈전전새;조Ⅱ 1례지속성방전환자인소융후제3천자행정용화법림출현단잠성뇌결혈발작,기여엄격항응적환자균미출현혈전사건.조Ⅰ여조Ⅱ소융술전후체도항응요구적지속성방전환자혈전사건발생솔차이유통계학의의(4/64대0/80,P=0.037).결론 소융중근거환자체중조정항응강도가이현저감소지속성방전환자위술기혈전사건병발증적발생.
Objective The relationships between different anticoagulation methods during radiofre-quency catheter ablation(RFCA) of persistent/permanent atrial fibrillation (AF)and thromboembolic events in our center were evaluated. Methods From July 2004 to October 2007, RFCA was consecutively performed in 145 persistent/permanent AF patients. Anticoagulation with warfarin was administrated in all patients before op-eration for at least 1 month, with the international normalized ratio(INR) maintained between 2.0 and 3.0. Be-fore procedure,warfarin was discontinued and replaced by low molecular weight heparin(LMWH). After atrial septum puncture,a total of 5000 U tmfractioned heparin(UFH) were given to patients of group Ⅰ who under-went the ablation from July 2004 to January 2006,while patients of group Ⅱ who underwent the ablation from February 2006 to October 2007 were heparinized(100 U/Kg) according to their weights. During operation, 1000 U UFH was appended per hour. After procedure, LMWH was used for 3 days while warfarin was initiated at the same time and continued for at least 3 months. Results Four patients in group Ⅰ (64 patients ,51 men)experi-enced thrombosis or embolism during or after ablation. One female persistent AF patient in the group Ⅱ (81 pa-tients,67 men)who didn' t fulfill the anticoagulatian therapy experienced TIA after ablation. No thrombeembolic event was identified in other patients of group Ⅱ who fulfilled the anticoagulation therapy. The incidence of thromboembolic event of persistent/permanent AF patients who fulfilled the anticoagulation therapy in the group Ⅱwas lower than that of group Ⅰ (4/64 vs. 0/80, P = 0.037). Conclusions Strengthen the anticoagulation therapy according to patients' weights during radiofrequency ablation could significantly decrease the incidence of thromboembolic event in patients with persistent/permanent AF.
