CAJ | 학술논문

目的观察心房颤动(房颤)射频导管消融术中经验性抗凝活化凝血时间(ACT)达标情况及短期术后血栓并发症发生情况.方法顺序入选2011年我院行射频导管消融治疗的阵发性或持续性房颤患者87例,术中均依据经验肝素抗凝(即首次穿刺房间隔后予负荷量肝素100 U/kg,术中每小时追加1000 U),术中定时监测ACT,如ACT≥250 s即为抗凝达标,ACT≥300 s则抗凝效果较好.观察ACT达标情况.随访终点:术后1个月脑卒中及严重出血情况(颅内出血、穿刺口血肿、皮肤黏膜出血).结果 87例患者测定ACT总体达标率为74.1％,未达标25.9％.ACT全程达标患者共45例,达标率为51.7％.术中术后无血栓及出血事件发生.结论虽然房颤消融术中经验性抗凝多数患者可以全程达标抗凝,但仍有部分患者部分时间ACT未达到抗凝标准,存在潜在血栓及出血不良事件发生风险,建议遵循指南进行术中ACT监测指导抗凝.大体重的阵发性房颤患者,术中经验性抗凝不易达标,需要加强抗凝,提高达标率.
목적 관찰심방전동(방전)사빈도관소융술중경험성항응활화응혈시간(ACT)체표정황급단기술후혈전병발증발생정황.방법 순서입선2011년아원행사빈도관소융치료적진발성혹지속성방전환자87례,술중균의거경험간소항응(즉수차천자방간격후여부하량간소100 U/kg,술중매소시추가1000 U),술중정시감측ACT,여ACT≥250 s즉위항응체표,ACT≥300 s칙항응효과교호.관찰ACT체표정황.수방종점:술후1개월뇌졸중급엄중출혈정황(로내출혈、천자구혈종、피부점막출혈).결과 87례환자측정ACT총체체표솔위74.1％,미체표25.9％.ACT전정체표환자공45례,체표솔위51.7％.술중술후무혈전급출혈사건발생.결론 수연방전소융술중경험성항응다수환자가이전정체표항응,단잉유부분환자부분시간ACT미체도항응표준,존재잠재혈전급출혈불량사건발생풍험,건의준순지남진행술중ACT감측지도항응.대체중적진발성방전환자,술중경험성항응불역체표,수요가강항응,제고체표솔.
Objective To evaluate the efficacy of empirical anticoagulation during AF ablation.Methods Eighty seven consecutive AF patients in our hospital were involved in this study.All patients underwent left atrial irrigated ablation.Based on our experiences,every patient received an intravenous heparin bolus 100 U/kg immediately after the initial transeptal access,followed by additional heparin 1000 U per hour until finishing procedures.In addition,irrigation rate was maintained at a continuous 2 ml/min of heparin saline (1 U/ml) during whole procedures while irrigation rate was set at 17-20 ml/min during ablation to protect the catheter from thrombosis.ACT of more than 250 seconds was regarded as effective anticoagulation.Hemorrhagic and thrombotic events during the procedure and 1 month after procedures were evaluated.Results Effective anticoagulation based on empirical administration of heparin was 74.1％.No thromboembolic or hemorrhagic events were observed.Conclusions Empirical administration of heparin during AF ablation procedure is effective and safe for most patients.But the potential risk of thromboembolic events still exist because of the substandard ACT during the procedure.It' s necessary to strengthen the monitoring of anti-coagulations.