CAJ | 학술논문

目的探讨高龄心房颤动(房颤)患者行导管消融治疗围术期有效而安全的抗凝方案.方法选取射频消融治疗的高龄(＞75岁)房颤患者15例(高龄组),术前服用华法林；同期＜75岁射频消融治疗房颤患者15例(非高龄组),根据栓塞风险服用华法林或阿司匹林治疗.术中均用肝素抗凝；高龄组术后以低分子肝素过渡,第3天开始服用华法林,非高龄组术后从第1天开始华法林与低分子肝素重叠应用3d;院外两组服用华法林抗凝3个月.3个月后根据CHADS2评分服用阿司匹林或华法林治疗.门诊随访至少12个月,比较两组凝血酶原时间-国际标准化比值(PT-INR)、6个月内出血和栓塞事件发生率及术后3、6、12个月24 h动态心电图记录心律失常情况.结果术前高龄组与非高龄组PT-INR值(1.58±0.32对1.37±0.44,P＞0.05),术后INR达标天数[(11.73±3.29)d对(9.71±3.63)d,P＞0.05];左心房内自发显影情况[3例(20.00％)对4例(26.67％),P＞0.05]；出血并发症(0对6.67％,P=0.05)、栓塞事件发生率(6.67％对0,P=0.05)差异无统计学意义.两组间术后3、6、12个月心律失常复发情况差异无统计学意义.结论高龄房颤患者行导管消融治疗术前需严格抗凝并排除心房血栓；术中抗凝与常规用药相同；术后延迟加用华法林治疗同样安全有效.
목적 탐토고령심방전동(방전)환자행도관소융치료위술기유효이안전적항응방안.방법 선취사빈소융치료적고령(＞75세)방전환자15례(고령조),술전복용화법림；동기＜75세사빈소융치료방전환자15례(비고령조),근거전새풍험복용화법림혹아사필림치료.술중균용간소항응；고령조술후이저분자간소과도,제3천개시복용화법림,비고령조술후종제1천개시화법림여저분자간소중첩응용3d;원외량조복용화법림항응3개월.3개월후근거CHADS2평분복용아사필림혹화법림치료.문진수방지소12개월,비교량조응혈매원시간-국제표준화비치(PT-INR)、6개월내출혈화전새사건발생솔급술후3、6、12개월24 h동태심전도기록심률실상정황.결과 술전고령조여비고령조PT-INR치(1.58±0.32대1.37±0.44,P＞0.05),술후INR체표천수[(11.73±3.29)d대(9.71±3.63)d,P＞0.05];좌심방내자발현영정황[3례(20.00％)대4례(26.67％),P＞0.05]；출혈병발증(0대6.67％,P=0.05)、전새사건발생솔(6.67％대0,P=0.05)차이무통계학의의.량조간술후3、6、12개월심률실상복발정황차이무통계학의의.결론 고령방전환자행도관소융치료술전수엄격항응병배제심방혈전；술중항응여상규용약상동；술후연지가용화법림치료동양안전유효.
Objective To evaluate the efficacy of anticoagulation therapy in the elderly (aged over 75) underwent catheter ablation for atrial fibrillation (AF).Methods Cather ablation for symptomatic AF was performed in 15 patients aged over 75 (11 men,mean age 77.6 ± 1.3) (advanced-aged group).Warfarin was used until 3-5 days before ablation,and transesophageal echocardiography (TEE) was performed.During the procedure heparin was used at a dose of 75 ～ 100 U/kg,3 days later after ablation.Warfarin was continued when using low molecular weight heparin as bridging therapy.During 12-months follow-up,the PT-INR,bleeding and thromboembolism complications,left atrium size,arrhythmias were compared between the two groups.Results There was no difference between the two groups in PT-INR,left atrium size,bleeding and thromboembolism complications rate.It took a longer duration in advanced-aged group to achieve PT-INR therapeutic range after ablation.In the two groups,the arrhythmias recurrence in 3,6,12 months was similar.Conclusions Strict anticoagulation therapy and TEE should be performed before procedure.The dosage of heparin during the procedure was routine dose.A delayed continuation of warfarin was effective and safe.