【作者】 张波；

【导师】 殷跃辉；

【作者基本信息】 重庆医科大学 ， 内科学（心血管病学）， 2016， 硕士

【摘要】 目的:分析较低活化凝血时间(ACT)条件下心房颤动消融术的安全性。方法:收集并整理于我院行射频导管或冷冻球囊消融术的231例心房颤动患者的临床资料。按消融术中所测ACT的平均值(以下简称ACT)分为<200s,200~<250s和≥250s三组,计算并比较各组栓塞及出血并发症的发生率,再按照是否发生出血并发症分为出血并发症组和无出血并发症组,按病例-对照研究进行单因素分析和多因素logistic回归分析出血并发症的危险因素。结果:ACT<200s,200~<250s和≥250s组的患者人数分别为27(11.69%),150(64.94%)和54(23.38%)例。CHADS2评分平均值为0.75±0.85。共有13例(5.63%)并发症:栓塞(脑梗塞)1例(0.43%)、出血8例(3.46%)[心包填塞4例(1.73%)和局部血肿4例(1.73%)]及周围血管并发症4例(1.73%)。栓塞和出血并发症均发生于200~<250s和≥250s组。与200~<250s组相比,≥250s组出血并发症发生率更高(1.3%:11.1%,P<0.01),3组其他并发症无显著差异。多因素logistic回归分析结果提示手术耗时(P<0.01,OR=1.025,95%CI:1.007~1.043)、公斤体重肝素注射量(P<0.01,OR=1.067,95%CI:1.020~1.116)及术中ACT平均值(P<0.01,OR=1.065,95%CI:1.017~1.114)是出血并发症的独立危险因素。结论:对CHADS2评分<2分的房颤患者,将消融术中ACT维持在200~<250s的是相对安全的,当ACT>250s时需注意出血风险。手术耗时、公斤体重肝素注射量及术中ACT水平是发生出血并发症的危险因素。更多还原

【Abstract】 Objective:To analyze the safety of atrial fibrillation(AF) ablation under lower activated clotting times(ACTs).Methods : Clinical data of 231 AF patients that underwent radiofrequency or cryoballoon ablation were collected. Averaged ACT during ablation procedure was calculated. According to the value of ACT, patients were divided into three groups: Averaged ACT <200 s, 200 ~ <250 s and ≥250 s. Embolic and bleeding complication rates of each group were analyzed. Then patients were categorized into bleeding group and non-bleeding group by the occurrence of bleeding complication. In this case-control study, univariate and multivariate logistic regression analysis were performed to identify the predictors of bleeding complications.Results: The number of patients with averaged ACT ranges of <200 s, 200 ~ <250 s and ≥250 s was 27(11.69%), 150(64.94%) and 54(23.38%) respectively. The mean CHADS2 score was 0.75±0.85. Complications occurred in 13(5.62%) patients totally, including 1(0.43%) embolism(stroke), 8(3.46%) bleeding [including 4(1.73%) cardiac tamponade and 4(1.73%) haematomas] and 4(1.73%) peripheral vascular complications. Both embolic and bleeding complications were observed in groups with averaged ACT of 200 ~ < 250 s and ≥250 s, while these two complications never occurred in <200 s group. Compared with 200 ~ <250 s group, bleeding complication rate of ≥250 s group was much higher(1.3% vs. 11.1%, P<0.01). Differences in other complications among the three groups were not significant. Multivariate logistic regression analysis indicated that the total procedural time(P<0.01, OR=1.025, 95%CI: 1.007~1.043), heparin bolus normalized for body weight(P<0.01, OR=1.067, 95%CI: 1.020~116) and averaged ACT(P<0.01, OR=1.065, 95%CI: 1.017~1.114) during ablation procedure were risk factors for bleeding complications.Conclusion: AF ablation is relatively safe with a target ACT of 200 ~ <250s for patients whose CHADS2 scores lower than 2, while bleeding risk should be taken into consideration when ACT appears to be over 250 s. Furthermore, the total procedural time, heparin bolus normalized for body weight and averaged ACT during ablation procedure prove to be predictors of bleeding complications.更多还原