射频消融术对凝血的影响及低分子肝素对其防治效果

Effects of radiofrequency catheter ablation on coagulant system and prophylactic therapy of low molecular weight heparin

目的旨在探讨预防射频消融术(RFCA)血栓栓塞并发症的方法。方法60例行RFCA患者随机分为两组,A组25例术后不应用肝素;B组35例术后6h开始予低分子肝素每日两次皮下注射,连用5天。两组患者再按左、右心导管操作各分成两个亚组。分别于术前、电生理检查(EPS)后即刻、RFCA后即刻及术后24h、3天及6天六个时段抽取静脉血,做血小板α颗粒膜糖蛋白140(GMP-140)、D-二聚体(DD)检测。结果①A组GMP-140EPS后开始升高,RFCA后即刻达到第一次峰值(20.95±2.02ng/ml),术后24h有所下降,术后3天达第二次峰值(22.24±1.94ng/ml)。B组RFCA后即刻GMP-140达到第一次峰值,术后3天未显示明显第二次峰值。术后3天、6天,B组明显低于A组。②两组DD自EPS后至术后3天逐渐升高,术后6天下降至术前水平。术后24h、3天、6天,B组明显低于A组。③两组亚组间GMP-140比较,各时刻均无差异。A组术后3天右心导管组DD明显高于左心导管组(1555±142ng/mlvs1352±193ng/ml),其余各时刻及B组各时段均无差异。结论RFCA术(无论左、右心导管操作)术后继续肝素化和联合抗血小板治疗十分必要。

Objective To discuss the pathogenesis and prophylactic therapy of thrombogenesis by radiofrequency catheter ablation（RFCA）. Methods 60 patients were divided into two groups randomly,25 patients of group A did not use heparin after RFCA. 35 patients of group B were given to low molecular weight heparin for 5 days after RFCA. Then all patients were divided into two subgroups by right and left catheterization in every group. Plasma platelet alpha-granular membrane glucoprotein（GMP-140） ,D-dimer（DD） concentration were measured at six different time points：before operation, after the electrophysiologic study（EPS） ,after the last RFCA immediately,and at 24 h,3 d,6 d after RFCA. Results ① Plasma GMP-140 exhibited a double peaked pattern in the groupe A： the first occurred instantly after RFCA （20.95 ± 2.02 ng/ml） ,it reached a second peak by 3 d later（22.24 ± 1.94 ng/ml）. In group B,the peak of GMP-140 was also present immediately after RFCA,but it did not show the second peak any more, and the level of GMP-140 was lower than that of group A at 3 d,6 d after RFCA respectively. ②Plasma DD in group A and B increased when EPS was finished,just the time RFCA was accomplished,and at the 24 h,3 d after RFCA,restored on the 6 d after RFCA. At 24 h,3 d,6 d after the procedure, the DD levels in group B were lower than that of in group A respectively. ③Left-sided or right-sided ablation had no effects on the level of GMP-140 and DD, except that DD level, showed a remarkable difference between the right-sided and the left-sided ablation subproup（ 1 555 ± 142 ng/ml vs 1 352 ± 193 ng/ml） in group A at 3 d after RFCA. Conclusions Subcutaneous low molecular weight heparin after RFCA can influence coagulation system and eliminate thrombolic events.