CAJ | 학술논문

目的：目前应用冷冻球囊导管消融治疗心房颤动(房颤)取得了较好的疗效,为了进一步提高消融术安全性,应详细分析围术期并发症发生的原因以降低消融术风险。方法回顾性分析2013年12月至2015年4月于沈阳军区总医院心内科采用冷冻球囊导管消融治疗的连续103例房颤患者围术期并发症。结果103例患者中男73例(70．9%),平均年龄(57．3±9．7)岁,其中高血压59例(57．3%),糖尿病18例(17．5%),平均左心房内径(35．5±6．9)mm,平均左心室舒张末期内径(46．8±4．3)mm,平均左心室射血分数0．65±0．15。术中发生迷走神经反射28例(27．2%),其中17例(60．7%)于左上肺静脉(LSPV)冷冻复温后发生,8例(28．6%)在左下肺静脉(LIPV)冷冻复温后发生。 LSPV及LIPV冷冻后均出现迷走神经反射2例(7．1%),LSPV及右上肺静脉(RSPV)冷冻后均出现迷走神经反射1例(3．6%)。其中严重迷走神经反射2例,均伴有窦性停搏和房室阻滞,1000~1200 ms起搏心室3~6 min不能出现自身窦性心律,需静推阿托品后逐渐好转。103例患者中,2例(1．94%)出现膈神经麻痹,其中1例术后3个月仍未恢复,另1例膈神经损伤患者15 min后好转,手术结束时膈肌已恢复运动。结论冷冻球囊导管消融房颤具有较好的安全性,对围术期可能出现的并发症应积极做好预防工作。
목적：목전응용냉동구낭도관소융치료심방전동(방전)취득료교호적료효,위료진일보제고소융술안전성,응상세분석위술기병발증발생적원인이강저소융술풍험。방법회고성분석2013년12월지2015년4월우침양군구총의원심내과채용냉동구낭도관소융치료적련속103례방전환자위술기병발증。결과103례환자중남73례(70．9%),평균년령(57．3±9．7)세,기중고혈압59례(57．3%),당뇨병18례(17．5%),평균좌심방내경(35．5±6．9)mm,평균좌심실서장말기내경(46．8±4．3)mm,평균좌심실사혈분수0．65±0．15。술중발생미주신경반사28례(27．2%),기중17례(60．7%)우좌상폐정맥(LSPV)냉동복온후발생,8례(28．6%)재좌하폐정맥(LIPV)냉동복온후발생。 LSPV급LIPV냉동후균출현미주신경반사2례(7．1%),LSPV급우상폐정맥(RSPV)냉동후균출현미주신경반사1례(3．6%)。기중엄중미주신경반사2례,균반유두성정박화방실조체,1000~1200 ms기박심실3~6 min불능출현자신두성심률,수정추아탁품후축점호전。103례환자중,2례(1．94%)출현격신경마비,기중1례술후3개월잉미회복,령1례격신경손상환자15 min후호전,수술결속시격기이회복운동。결론냉동구낭도관소융방전구유교호적안전성,대위술기가능출현적병발증응적겁주호예방공작。
Objectives Good curative effect had been obtained in cryoballoon ablation for atrial fibril-lation,and complications should be analyzed in order to improve operation safety. Methods From December 2013 to April 2015,complications were analyzed in 103 patients with atrial fibrillation underwent cryoballoon ablation in Shenyang Northern Hospital. Results In the 103 patients,there were 73 males (70. 9%),the mean age was (57. 3±9. 7)years. Fifty-nine patients (57. 3%) had hypertension,and 18 patients (17. 5%) had dia-betes mellitus. The mean left atrial diameter(LAD) was (35. 5±6. 9) mm,the mean left ventricular end dias-tolic diameter(LVEDD) was (46. 8±4. 3) mm,and the mean left ventricular ejection fraction (LVEF) was 0. 65±0. 15. Vagal reflex occured in 28 patients (27. 2%),and 17(60. 7%) was in left superior pulmonary vein (LSPV),8(25. 0%)was in left inferior pulmonary vein (LIPV),2(7. 1%) in both LSPV and LIPV,and 1(3. 6%) in both LSPV and right superior pulmonary vein (RSPV). Among them,serious vagal reflex occured in 2 patients with sinus arrest and atrioventricular block and right ventricular pacing was used ( 1 000-1 200 ms). After atropine injection (0. 5-1. 0 mg),sinus rate appeared 6 mins later. Phrenic nerve palsy oc-cured in 2 patients,1 was recovered in 15 mins and the other was not recovered at the 3-month follow-up. Conclusions Cryoballoon ablation for atrial fibrillation is relatively safe and prevention should be done to avoid complications.