阿司匹林联合疏血通注射液对射频消融术后血栓前状态的作用及护理观察

Influence of radiofrequency catheter ablation and effect of aspirin and injection of Shuxuetong on prethrombotic state

目的观察阿司匹林联合疏血通注射液对射频消融术（RFCA）血栓前状态的干预作用。方法选择需要行RFCA的阵发性室上性心动过速的患者70例，随机分成4组，A组（n=20）：术前3d静脉滴注疏血通注射液，术后继续静脉滴注5d；B组（n=16）：术前3d口服阿司匹林（Asp）；C组（n=18）：术前3d静脉滴注疏血通注射液联合口服Asp，术后继续静脉滴注疏血通注射液5d；D组（n=16）：术前术后不用药。分别于术前（T0）、电生理检查后（T1）、RFCA后即刻（T2）、术后2d（T3）、术后5d（T4）5个时段采血，测定血小板α颗粒膜糖蛋白140（GMP—140）、D-二聚体（DD）和血管性血友病因子（vWF），比较四组不同时段各项指标的变化及组间差异，并进行RFCA的程序变量与血栓前状态的分子标志物变化的相关性分析。结果A组及C组RFCA各时段GMP-140、DD及vWF无显著性差异；B组GMP-140无显著性变化，DD、vWF显著升高，以消融完成后升高最明显；D组GMP-140、DD及vWF均显著升高，以消融完成后升高最明显。结论RFCA术可导致血栓前状态，阿司匹林联合疏血通注射液可阻止血小板的激活，改善凝血和纤溶系统的双重激活，有阻止血栓形成的作用。

Objective To investigate the influence of radio frequency catheter ablation （RFCA） on prethrombotic state and evaluate the effect of pretreatment with injection of Shuxuetong. Methods Seventy patients with superaventrieular tachyeardia undergoing RFCA were randomized to control pretreatment group A （n = 20 ） with injection of Shuxuetong （6 ml/d） for three days prior, pretreatment group B （n = 16） with aspirin for three days prior before RFCA, group C （ n = 18） with aspirin and injection of Shuxuetong （6 ml/d） for three days prior and group D （n = 16） without pretreatment before RFCA, GMP - 140, vWF, D - dimer levels of plasma were measured at different points ： before RFCA （ T1 ）, after the EPS （ T2 ）, immediately after the RFCA （ T3 ） , at two days after RFCA （ T4 ） and at five days after RFCA （ T5 ） . The changes within groups at different time points and the differences between groups at same time points were compared. Results （1）group A and C There were no remarkable difference time points in the groups for the levels of GMP - 140, vWF and D -dimer comparing before RFCA. （2）group B There were no remarkable elevation in the levels of plasma GMP - 140 at different time points, However, D -dimer still elevated, further rose to peak values immediately after RFCA, （3）group D GMP - 140, D -dimer and vWF levels of plasma increased significantly , further rose to peak values immediately after RFCA. Conclusion The prethrombotic state can be introduced by RFCA. Pretreatment with injection of Shuxuetong can prevent prethrombotic state.