【摘要】 目的探讨经房间隔穿刺射频消融治疗左侧后间隔房室旁道的临床效果及安全性。方法随机选择2013年1月~2015年12月于郑州市心血管病医院心内科收治的73例左侧后间隔房室旁道患者,采取数字表法分为经房间隔穿刺射频消融治疗32例(研究组)、经动脉逆行途径射频消融治疗41例(对照组),比较分析两种治疗的临床疗效、安全性,及两组患者手术前、后左心室功能变化。结果研究组的手术时间(68.8±19.6)min、X线曝光时间(15.6±4.5)min以及放电时间(3.2±2.1)min均显著低于对照组(P<0.05);两组间消融次数、手术成功率及术后6个月的复发率差异不显著(P>0.05);两组患者组间和组内术前及术后第3 d的心功能参数,包括舒张早期充盈峰值速度(E)、心房充盈峰值速度(A)、等容舒张时间(IVRT)、左室射血分数(LVEF)、左室短轴缩短率(LVSF)及每搏输出量(SV)值差异均不显著(P>0.05)。结论经房间隔穿刺射频消融与经动脉逆行途径射频消融治疗左侧后间隔房室旁道的临床效果相近,射频消融的能量范围控制均较好,对左室心功能影响不大,但经房间隔穿刺能够缩短手术时间、X线曝光时间、放电时间,从而能够有效减少射线给患者及医务人员带来的损伤。更多还原

【Abstract】 Objective To evaluate efficacy and safety of transseptal approaches for radiofrequency ablation of left posterior septal atrioventricular accessory pathways. Methods 73 patients with left posterior septal atrioventricular accessory pathways were randomly selected from January 2013 to December 2015. 32 patients were treated by transseptal approaches(study group), other 41 patients were treated by transaortic approaches(control group). The clinical efficacy and safety of the two treatments and the changes of left ventricular function before and after operation were compared. Results Discharge time, frequencies of surgery, x-ray exposure and total operation time in the study group were significantly decreased than those of control group(P<0.05). There was no significant difference of success rate and recurrence rate after 6 months between two groups(P>0.05). There was no significant difference in the left ventricular cardiac function measurements before and after operation, including diastolic early filling peak velocity(E), atrial filling peak velocity(A), isometric diastolic time(IVRT), left ventricular ejection fraction(LVEF), left ventricular fractional shortening(LVFS) and stroke volume(SV)(P>0.05). ConclusionTransseptal approach for radiofrequency ablation of left posterior septal atrioventricular accessory pathways not only has similar clinical efficacy and safety with that of transaortic approach, but also decreases the operation time, x-ray exposure time and the discharge time. Therefore, transseptal approach is a feasible, safe and effective method for radiofrequency ablation of left posterior septal atrioventricular accessory pathways.更多还原