姚青,宋治远,郭燕丽,舒茂琴,李华康,黄海韵,刘锋,万陈,李林峪,汪雪琴,秦浩然,刘燕,黄雪娇

• 1:陆军军医大学附属西南医院心内科
• 2:陆军军医大学附属西南医院超声诊断科

摘要(Abstract)：

目的评价经皮左心耳封堵术(LAAC)在非瓣膜性心房颤动(房颤)患者中的临床效果与安全性。方法纳入2014年8月至2018年6月在陆军军医大学附属西南医院住院并接受LAAC治疗的非瓣膜性房颤患者,计算CHA2DS2-VASc及HAS-BLED评分;在全麻下行LAAC,术后定期随访,复查经胸超声心动图(TTE)及经食管超声心动图(TEE);并对患者基线资料、左心耳测量数据、LAAC相关资料及术后抗栓方案进行汇总分析,比较LAAC前后TTE及TEE监测结果变化及转归。结果共259例非瓣膜性房颤患者接受LAAC,其中男118例(45.6%),平均年龄(68.2±8.6)岁。CHA2DS2-VASc评分(4.2±1.4)分,HASBLED评分(3.2±0.4)分;259例患者中256例(98.8%)LAAC获得成功,其中253例置入Watchman封堵器[平均直径(26.4±3.6)mm,封堵器平均压缩率(20.1±6.8)%],3例置入ACP封堵器。术后即刻TEE监测显示28例(10.9%)有少量残余分流(≤5 mm)。围术期较严重并发症4例(1.5%,4/259),其中3例(1.2%)为迟发性心脏压塞,均经心包穿刺置管引流治愈,另1例考虑空气栓塞,未处理自行恢复。平均随访(25.9±7.9)个月,TEE发现器械相关血栓形成7例(2.7%,7/256),均经延长抗凝治疗或改服抗凝药物后血栓消失。所有患者均未发生器械脱落、血栓栓塞及严重出血并发症。结论 LAAC作为预防非瓣膜性房颤患者卒中的一项新技术,其临床应用是安全、有效的。

关键词(KeyWords)： 非瓣膜性心房颤动;左心耳封堵术;Watchman封堵器;ACP封堵器

Abstract:

Keywords:

基金项目(Foundation): 重庆市社会民生科技创新专项资助项目(cstc2015shmszx0002)

作者(Author): 姚青,宋治远,郭燕丽,舒茂琴,李华康,黄海韵,刘锋,万陈,李林峪,汪雪琴,秦浩然,刘燕,黄雪娇

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