本文選題：房顫　切入點(diǎn)：導(dǎo)管消融　出處：《浙江大學(xué)》2016年碩士論文

【摘要】：目的：對(duì)于非瓣膜性房顫患者,左心耳是90%血栓的來(lái)源位置。導(dǎo)管消融是一種可以有效治療癥狀性房顫的手術(shù),同時(shí)左心耳封堵術(shù)是一種能有效預(yù)防房顫患者發(fā)生腦卒中的手術(shù)。而在單次手術(shù)手術(shù)中同時(shí)進(jìn)行導(dǎo)管消融和左心耳封堵術(shù)的安全性和可行性尚且不明確。方法：對(duì)26例在我院診斷為非瓣膜性房顫、符合條件的患者進(jìn)行導(dǎo)管消融聯(lián)合左心耳封堵手術(shù)。導(dǎo)管消融采用肺靜脈電位隔離術(shù),左心耳封堵采用Watchman封堵器植入術(shù)。結(jié)果：本次研究共入選26例患者(其中女性10例),患者平均年齡為64±10歲(范圍為46-83歲),CHA2DS2-VASc評(píng)分的平均分為3.5±1.6分(范圍為2-7分),HAS-BLED評(píng)分的平均分為2.4±1.1分(范圍為1-5分)。其中有11例(42%)患者有腦梗死的病史。所有的病人均成功完成聯(lián)合手術(shù)(100%)。手術(shù)的平均時(shí)間為162.8±61.2分(范圍為52-284分)。術(shù)后所有病人的左心耳都達(dá)到了封堵標(biāo)準(zhǔn),完全封堵的有22例(84.6%)。術(shù)后3月有4例新發(fā)的封堵傘周殘余漏,但是仍然在封堵標(biāo)準(zhǔn)之內(nèi)。圍手術(shù)期并發(fā)癥主要有2例患者有心包積液。手術(shù)后左心房的結(jié)構(gòu)沒(méi)有產(chǎn)生顯著改變(4.3cm vs 4.3cm, p 0.05),但是患者的射血分?jǐn)?shù)有明顯的提升(60.4%vs 66.9%,p0.05)。隨訪中沒(méi)有出現(xiàn)死亡、腦卒中、心包積液、出血、器械栓塞等并發(fā)癥。有1例患者半年后房顫復(fù)發(fā)。結(jié)論：一次性完成導(dǎo)管消融聯(lián)合左心耳封堵手術(shù)對(duì)于中國(guó)非瓣膜性房顫患者是可行的,安全的,有效的。這可以作為藥物難治療的癥狀性房顫患者,高腦卒中風(fēng)險(xiǎn)房顫患者和對(duì)口服抗凝藥有相對(duì)或者絕對(duì)禁忌癥患者的治療方案。
[Abstract]:Objective: in patients with non-valvular atrial fibrillation, the left atrial appendage is the source of 90% thrombus.Catheter ablation is an effective procedure for the treatment of symptomatic atrial fibrillation and left atrial appendage occlusion is an effective procedure to prevent stroke in patients with atrial fibrillation.However, the safety and feasibility of simultaneous catheter ablation and left atrial appendage closure in a single operation are unclear.Methods: 26 patients with non-valvular atrial fibrillation who were diagnosed as non-valvular atrial fibrillation were treated with catheter ablation combined with left atrial appendage closure.Catheter ablation was performed with pulmonary vein potential isolation and left atrial appendage occlusion with Watchman occluder.Among them, 11 cases had a history of cerebral infarction.All the patients successfully completed the combined operation.The mean operation time was 162.8 鹵61.2 minutes (range: 52-284 minutes).The left atrial appendage of all the patients reached the standard of occlusion after operation, and 22 patients were completely occluded (84.6%).Three months after operation, 4 cases had residual leakage around the occluder, but it was still within the standard of occlusion.Pericardial effusion was found in 2 patients with perioperative complications.There was no significant change in the structure of the left atrium after operation (4.3 cm vs 4.3 cm, p 0.05), but the ejection fraction of the patients was significantly improved by 60.4 cm vs 66.9 cm.No complications such as death, stroke, pericardial effusion, hemorrhage, instrumentation embolism were observed during follow-up.One patient recurred after half a year of atrial fibrillation.Conclusion: one-time catheter ablation combined with left atrial appendage closure is feasible, safe and effective for patients with non-valvular atrial fibrillation in China.This can be used as a treatment regimen for symptomatic atrial fibrillation patients with refractory drugs, patients with high stroke risk atrial fibrillation and patients with relative or absolute contraindications to oral anticoagulants.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.75

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 周自強(qiáng),胡大一,陳捷,張仁漢,李奎寶,趙秀麗;中國(guó)心房顫動(dòng)現(xiàn)狀的流行病學(xué)研究[J];中華內(nèi)科雜志;2004年07期

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本文編號(hào)：1701368