中国介入心脏病学杂志
中國介入心髒病學雜誌
중국개입심장병학잡지
CHINESE JOURNAL OF INTERVENTIONAL CARDIOLOGY
2014年
4期
220-224
,共5页
佟佳宾%施海峰%邹彤%陈浩%刘俊鹏%王华%李莹莹%吕游%种甲%董敏%杨杰孚
佟佳賓%施海峰%鄒彤%陳浩%劉俊鵬%王華%李瑩瑩%呂遊%種甲%董敏%楊傑孚
동가빈%시해봉%추동%진호%류준붕%왕화%리형형%려유%충갑%동민%양걸부
心房颤动%导管消融%抗凝治疗%血栓栓塞
心房顫動%導管消融%抗凝治療%血栓栓塞
심방전동%도관소융%항응치료%혈전전새
Atrial ifbrillation%Catheter ablation%Anticoagulation therapy%Thromboembolism
目的：观察大于75岁的高龄心房颤动（房颤）患者围导管消融期三种抗凝方案的安全有效性。方法选取2011年7月到2013年12月行房颤导管消融治疗的高龄（＞75岁）房颤患者85例，术前常规华法林抗凝后经食管超声检查排除左心耳血栓，分为三组：传统抗凝组30例，消融前停用华法林，以低分子肝素桥接，术中用普通肝素抗凝，术后桥接低分子肝素联合华法林过渡到单用华法林；华法林持续使用组32例，围消融期正常使用华法林，术中使用普通肝素抗凝；新型口服抗凝药物组23例（达比加群组12例，利伐沙班组11例），术前、术中同传统抗凝组，术后4h开始服用达比加群或利伐沙班抗凝。比较三组抗凝方案围术期到术后3个月的出血和栓塞事件发生率及其他并发症。结果传统抗凝组住院期间新发脑梗死1例，下肢血肿7例，假性动脉瘤1例，出院后3个月内内脏出血1例，小出血事件6例；华法林持续使用组院内下肢血肿4例，出院后3个月内小出血事件4例；新型口服抗凝药物院内下肢血肿2例，出院后无小出血事件。结论高龄房颤患者行导管消融治疗，总体安全有效。与传统抗凝治疗方案对比，持续使用华法林方案或采用新型口服抗凝药物能进一步降低出血并发症风险，并未增加血栓栓塞的风险。
目的：觀察大于75歲的高齡心房顫動（房顫）患者圍導管消融期三種抗凝方案的安全有效性。方法選取2011年7月到2013年12月行房顫導管消融治療的高齡（＞75歲）房顫患者85例，術前常規華法林抗凝後經食管超聲檢查排除左心耳血栓，分為三組：傳統抗凝組30例，消融前停用華法林，以低分子肝素橋接，術中用普通肝素抗凝，術後橋接低分子肝素聯閤華法林過渡到單用華法林；華法林持續使用組32例，圍消融期正常使用華法林，術中使用普通肝素抗凝；新型口服抗凝藥物組23例（達比加群組12例，利伐沙班組11例），術前、術中同傳統抗凝組，術後4h開始服用達比加群或利伐沙班抗凝。比較三組抗凝方案圍術期到術後3箇月的齣血和栓塞事件髮生率及其他併髮癥。結果傳統抗凝組住院期間新髮腦梗死1例，下肢血腫7例，假性動脈瘤1例，齣院後3箇月內內髒齣血1例，小齣血事件6例；華法林持續使用組院內下肢血腫4例，齣院後3箇月內小齣血事件4例；新型口服抗凝藥物院內下肢血腫2例，齣院後無小齣血事件。結論高齡房顫患者行導管消融治療，總體安全有效。與傳統抗凝治療方案對比，持續使用華法林方案或採用新型口服抗凝藥物能進一步降低齣血併髮癥風險，併未增加血栓栓塞的風險。
목적：관찰대우75세적고령심방전동（방전）환자위도관소융기삼충항응방안적안전유효성。방법선취2011년7월도2013년12월행방전도관소융치료적고령（＞75세）방전환자85례，술전상규화법림항응후경식관초성검사배제좌심이혈전，분위삼조：전통항응조30례，소융전정용화법림，이저분자간소교접，술중용보통간소항응，술후교접저분자간소연합화법림과도도단용화법림；화법림지속사용조32례，위소융기정상사용화법림，술중사용보통간소항응；신형구복항응약물조23례（체비가군조12례，리벌사반조11례），술전、술중동전통항응조，술후4h개시복용체비가군혹리벌사반항응。비교삼조항응방안위술기도술후3개월적출혈화전새사건발생솔급기타병발증。결과전통항응조주원기간신발뇌경사1례，하지혈종7례，가성동맥류1례，출원후3개월내내장출혈1례，소출혈사건6례；화법림지속사용조원내하지혈종4례，출원후3개월내소출혈사건4례；신형구복항응약물원내하지혈종2례，출원후무소출혈사건。결론고령방전환자행도관소융치료，총체안전유효。여전통항응치료방안대비，지속사용화법림방안혹채용신형구복항응약물능진일보강저출혈병발증풍험，병미증가혈전전새적풍험。
Objective To observe the safety and efficacy of different periprocedural anticoagulation strategies in patients undergoing catheter ablation of atrial ifbrillation. Methods Eighty-five patients aged over 75 undergoing catheter ablation of atrial fibrillation from Jul 2011 to Nov 2013 were enrolled. They all took warfarin and transesophageal echocardiograms were performed to rule out left atrium appendage thrombus before ablation. They were divided into 3 groups. In Group 1 (30 cases), warfarin was stopped and bridged with low molecular weight heparin (LMWH) 3 days before procedure and LMWH bridging followed by warfarin alone after procedure. In Group 2 (32 cases), warfarin was continued during periprocedural period. In Group 3 (23 cases), Dabigatran or Rivaroxaban alone was used 4 hours after procedure respectively. Unfractionated heparin was used during procedure in all three groups. These three anticoagulation strategies were compared in bleeding, embolism events and other complications during 3-month follow-up. Results In Group 1, there were 1 new-onset ischemic stroke during hospitalization, 7 lower extremity hematomas, 1 subdural hemorrhage during 3-month follow-up and 6 minor bleeding events. In Group 2, there were 4 lower extremity hematomas and 4 minor bleeding events during 3-month follow-up. As for Group 3, only 2 lower extremity hematomas during hospitalization was observed in each without any minor bleeding events during follow-up. Conclusions Catheter ablation in elderly atrial ifbrillation patients was safe and effective in general. Compared with traditional anticoagulation strategy, continuing warfarin or novel oral anticoagulants could reduce bleeding complications without increasing thromboembolism risk.
