左心耳封堵術(LAAC)用于接受其他心臟介入手術治療的心房纖顫(房顫)患者的安全性及可行性分析

陸宏 陶杰 羅雪婷 黃宏波

[摘要] 目的 分析左心耳封堵術（LAAC）用于接受其他心臟介入治療的心房纖顫（房顫）患者的安全性及可行性。方法方便選取2016年1月—2018年6月期間該院接收的18例心房纖顫患者作為研究對象，所有患者均在進行左心耳封堵術進行治療時，接受其他心臟介入手術治療，觀察并分析患者經過治療后的臨床效果和安全性。結果 18例患者左心耳封堵術均手術成功，其中左心耳最大直徑為17～29 cm，封堵器直徑為27～35 mm，封堵器壓縮比為16.5%～32.9%，封堵器與推送桿完全解離后僅發現1例患者封堵器附近出現殘余分流（3 mm），剩余17例均未出現殘余分流;同時，經過術后隨訪，18例患者均未出現任何出血情況和動脈栓塞事件。結論 心房纖顫患者在接受導管主動脈瓣置換術、經皮冠狀動脈介入以及心導管射頻消融術心臟介入手術治療時，予以左心耳封堵術，能夠有效改善患者臨床癥狀，控制患者術后出血與動脈栓塞等不良事件的發生，具有可行性與安全性。

[關鍵詞] 左心耳封堵術;心臟介入手術;心房纖顫;安全性;可行性

[中圖分類號] R541 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1674-0742（2020）04（a）-0045-03

[Abstract] Objective To analyze the safety and feasibility of left atrial appendage occlusion （LAAC） in patients with atrial fibrillation （AF） undergoing other cardiac interventions. Methods Eighteen patients with atrial fibrillation received in the hospital from January 2016 to June 2018 were conveniently selected as the study subjects. All patients received other interventional cardiac surgery during the treatment of left atrial appendage occlusion. The clinical effect and safety of the patients after treatment were observed and analyzed. Results All 18 patients were successfully operated. The maximum diameter of left atrial appendage was 17-29 cm， the diameter of occluder was 27-35 mm， and the compression ratio of occluder was 16.5%-32.9%. Only one patient had residual shunt （3 mm） near the occluder after the occluder and push rod were completely removed. No residual shunt was found in the remaining 17 patients. At the same time， after follow-up， no bleeding or arterial embolism occurred in 18 patients. Conclusion The left atrial appendage occlusion in patients with atrial fibrillation undergoing catheter aortic valve replacement， percutaneous coronary intervention and cardiac catheter radiofrequency ablation can effectively improve the clinical symptoms of patients and control the occurrence of adverse events such as bleeding and arterial embolism.

[Key words] Left atrial appendage occlusion; Cardiac interventional surgery; Atrial fibrillation; Safety; Feasibility

心房纖顫（房顫）是臨床十分常見的一種持續性心律失常，具有發病率高的特點，這種疾病會很大程度增加發生心力衰竭和卒中的風險，預后效果差，影響患者生存質量，同時增加患者醫療負擔[1]。房顫患者長期服用抗凝藥物是主要的治療方式之一，但口服抗凝藥具有較高的出血風險，且患者依從性差，效果不夠理想，因此，非藥物手段是臨床治療房顫的研究重點，目前主要以導管主動脈瓣置換術、經皮冠狀動脈介入以及心導管射頻消融術這3種為首選方式[2]?！?br>