赵志宏,罗俊,武英彪,王赛华,朱茜,方明,郇强,张小刚,朱珞宁,田蓓,顾薇,宁忠平

• 1:上海健康医学院附属周浦医院心内科

摘要(Abstract)：

目的分析心房颤动合并左心耳血栓行左心耳封堵术的安全性和有效性。方法连续入选上海健康医学院附属周浦医院11例经冠状动脉计算机断层扫描血管成像(CTA)和经食管超声心动图(TEE)确诊左心耳血栓,抗凝方案治疗,但不能耐受长期抗凝及抗凝无效时,行左心耳封堵治疗的心房颤动患者纳入研究。结果心房颤动患者包括阵发性、持续性和长程持续性心房颤动,平均年龄为78岁(57～93岁),CHA_2DS_2-VASc评分平均值为6.2(4～8)分,HAS-BLED评分平均值为3.6(2～6)分。左心耳血栓2型(近端至中端)和3型(远端)分别有2例和9例。3例患者抗凝治疗左心耳血栓消失后行左心耳封堵术,8例患者左心耳血栓存在情况下行左心耳封堵术(1例为2型血栓,7例为3型血栓)。2例患者左心耳血栓消失病例采用Watchman封堵器,其他患者均用LAmbre封堵器完成左心耳封堵术。1例患者左心耳LAmbre封堵术后住院期间发生短暂性脑缺血发作,出院后随诊未再发生;其他病例未发生任何明显的围术期不良事件。术后8～12周TEE复查,3例发生左心耳器械相关血栓,继续抗血小板药物联合华法林或非维生素K口服抗凝药(NOACs)抗凝方案。中位随访时间为6(6,13)个月,随访期间未发生心血管和全因死亡、重大缺血性脑血管事件、心力衰竭恶化和重大出血事件。结论对于心房颤动合并左心耳血栓患者首选华法林或NOACs抗凝方案,抗凝无效或不能耐受、适宜左心耳封堵术的左心耳血栓患者,可选择左心耳封堵术作为替代治疗方案。

关键词(KeyWords)： 心房颤动;左心耳;左心耳血栓;左心耳封堵术

Abstract:

Keywords:

基金项目(Foundation): 上海市医学重点专科建设基金（ZK2019B25）;; 浦东新区卫计委高原学科建设基金（PWYgy2018-03）;浦东新区卫计委重点专科建设基金（PWZzk2017-01）

作者(Author): 赵志宏,罗俊,武英彪,王赛华,朱茜,方明,郇强,张小刚,朱珞宁,田蓓,顾薇,宁忠平

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