本文選題：經(jīng)皮心包穿刺　切入點：心外膜　出處：《上海醫(yī)學》2017年04期

【摘要】：目的評價劍突下經(jīng)皮心包穿刺途徑標測和消融室性心律失常(VA)的安全性和有效性。方法回顧性分析2014年6月—2015年12月在復旦大學附屬中山醫(yī)院心內(nèi)科于劍突下經(jīng)皮心包穿刺途徑進行標測和消融的10例VA患者的臨床資料,男8例、女2例,年齡16~69歲;其中特發(fā)性VA 1例,器質(zhì)性心臟病合并室性心動過速(VT)9例(非缺血性心肌病8例,缺血性心肌病1例)。9例器質(zhì)性心臟病患者中,6例術(shù)前已植入器械[植入式心臟復律除顫器(ICD)、心臟再同步治療聯(lián)合ICD各3例]。4例患者既往有1次心內(nèi)膜消融失敗史。分析所有患者心包穿刺并發(fā)癥的發(fā)生情況,以及導管消融的策略和效果。結(jié)果所有患者劍突下經(jīng)皮心包穿刺均獲成功。術(shù)后僅1例患者發(fā)生心包出血,考慮由穿刺刺破心室壁所致,經(jīng)引流后好轉(zhuǎn);無1例患者發(fā)生急性心包填塞、冠狀動脈損傷、鄰近臟器損傷、膈神經(jīng)損傷等并發(fā)癥。1例特發(fā)性VA患者經(jīng)聯(lián)合心內(nèi)膜-心外膜標測提示VA起源心肌壁內(nèi),最后于心內(nèi)膜側(cè)大功率(45 W)延長消融時間(90s,2次)后急性消融成功。9例器質(zhì)性心臟病合并VT患者行基質(zhì)改良消融,其中7例急性消融成功(均為非缺血性心肌病患者),2例急性消融失敗。這2例患者經(jīng)心內(nèi)膜-心外膜聯(lián)合標測后提示VA起源心肌壁內(nèi)深處,嘗試將消融導管送入冠狀靜脈竇分支亦均失敗。4例既往行消融但失敗的患者,本次行心內(nèi)膜-心外膜聯(lián)合標測后,3例經(jīng)心外膜消融成功,1例心內(nèi)膜消融成功。8例消融成功的患者術(shù)后隨訪3~12個月,2例VA復發(fā),其中1例患者于消融術(shù)后3個月因頑固性心力衰竭死亡。結(jié)論劍突下經(jīng)皮心包穿刺途徑標測和消融VA安全、有效,聯(lián)合心內(nèi)膜-心外膜標測和消融能提高器質(zhì)性心臟病合并VT患者的導管消融成功率。
[Abstract]:Objective to evaluate the safety and efficacy of percutaneous pericardial aspiration mapping and ablation of ventricular arrhythmias via subxiphoid pericardiocentesis. Methods from June 2014 to December 2015 at Zhongshan Hospital affiliated to Fudan University, we retrospectively analyzed the efficacy and safety of subxiphoid meridians in the Department of Cardiology of Zhongshan Hospital affiliated to Fudan University. Clinical data of 10 patients with VA by percutaneous pericardial puncture. There were 8 males and 2 females aged 1669 years, including 1 case of idiopathic VA and 9 cases of VT with ventricular tachycardia (8 cases of non-ischemic cardiomyopathy, 8 cases of non-ischemic cardiomyopathy). One patient with ischemic cardiomyopathy, one patient with organic heart disease, 6 patients who had implanted instruments before operation [implantable cardioverter defibrillator, 3 patients with cardiac resynchronization combined with ICD] .4 patients had a history of failure of endocardial ablation before operation. To analyze the incidence of pericardial puncture complications in all patients, Results Percutaneous pericardial puncture was successful in all patients. Only one patient had pericardial hemorrhage after operation, which was caused by puncture of ventricular wall and improved after drainage. No one patient developed acute pericardial tamponade, coronary artery injury, adjacent organ injury, phrenic nerve injury and other complications. At last, 9 patients with organic heart disease complicated with VT were treated with modified matrix ablation. Among them, 7 cases were successfully ablated (all of them were patients with non-ischemic cardiomyopathy) and 2 cases were failed in acute ablation. The results of endocardial and epicardial mapping showed that VA originated from the deep wall of myocardium. Attempts to transfer catheter into the coronary sinus branch also failed in 4 patients who had failed in previous ablation. In this study, 3 patients underwent endocardial and epicardial mapping and 1 patient was successfully ablated through epicardium. Two patients with VA recurrence were followed up for 3 to 12 months after successful endocardial ablation. One patient died of intractable heart failure 3 months after ablation. Conclusion it is safe and effective to map and ablate VA by percutaneous pericardial puncture under the xiphoid process. Combined endocardial-epicardial mapping and ablation can improve the success rate of catheter ablation in patients with organic heart disease complicated with VT.
【作者單位】： 復旦大學附屬中山醫(yī)院心內(nèi)科 上海市心血管病研究所;
【基金】：國家自然科學基金資助項目(81521001)
【分類號】：R541.7

【相似文獻】

相關(guān)期刊論文 前10條

1 施陳剛;心包穿刺的臨床應用與評價──附37例次臨床分析[J];遼寧醫(yī)學雜志;1994年01期

2 林宏祥;心包穿刺并發(fā)癥5例搶救的體會[J];中國實用內(nèi)科雜志;1996年10期

3 劉志琴，張陳勻;心包穿刺方法的改進[J];中國介入心臟病學雜志;1996年03期

4 王海洪,張?zhí)煸?心包穿刺置管引流15例[J];河北醫(yī)藥;2001年01期

5 施劍如,陳慧穎,盧正飛;心電圖監(jiān)護、超聲引導下心包穿刺65例分析[J];上海生物醫(yī)學工程;2002年04期

6 劉闖,董建增,張麗,張金盈,邱春光,李華;心包穿刺引流部位與引流程度及安全性的關(guān)系[J];中國綜合臨床;2005年07期

7 劉闖,董建增,張麗,張金盈,邱春光,李華;心包穿刺引流部位與安全性及引流程度關(guān)系的探討[J];醫(yī)師進修雜志;2005年13期

8 嚴華,陳麗媛,陳湘桂,黃軍章,符春暉;X線透視下心包穿刺并置管引流(附21例報告)[J];廣西醫(yī)科大學學報;2005年01期

9 厲永征;王衛(wèi)紅;鞏延麗;;心包穿刺置管引流部位與其安全性及引流程度關(guān)系的探討[J];山東醫(yī)藥;2006年13期

10 盧亮元;;心包穿刺置管引流16例分析[J];內(nèi)蒙古中醫(yī)藥;2009年13期

相關(guān)會議論文 前4條

1 王雪樵;劉傳垠;萬風福;;床邊心包穿刺中心靜脈置管在心包積液診治中的應用價值[A];第八次全國中西醫(yī)結(jié)合心血管病學術(shù)會議論文集[C];2007年

2 曾建新;;超聲引導心包穿刺治療心包積液[A];第九屆全國超聲心動圖學術(shù)會議論文集[C];2007年

3 張越;宋玉林;王春麗;曹瑋;;超聲引導下應用EV套管針心包穿刺治療心包積液[A];第九屆全國超聲心動圖學術(shù)會議論文集[C];2007年

4 詹賢章;吳書林;楊平珍;薛玉梅;方咸宏;廖洪濤;梁遠紅;張黔桓;王培寧;;心包穿刺技術(shù)在心外膜心律失常消融中的應用體會[A];中華醫(yī)學會心電生理和起搏分會第十次全國學術(shù)年會會議匯編[C];2012年

相關(guān)碩士學位論文 前1條

1 馬文菲;需要進行心包穿刺和引流的心包積液患者的臨床特點研究[D];華中科技大學;2011年

，

本文編號：1675916