心房颤动导管消融的围手术期护理与并发症处理

Perioperative nursing and complications treatment in patients undergoing catheter ablation of atrial fibrillation

目的:探讨在三维电解剖标测(Three-dimensional electroanatomical mapping,CARTO)系统指导下进行射频消融治疗心房颤动的护理方法及并发症的处理。方法:对81例反复发作的阵发性房颤和17例持续性房颤行射频消融术治疗的患者进行观察和护理。术前做好心理护理,术后密切观察患者生命体征,加强并发症的观察和护理。结果:87.65%(71/81)的阵发性房颤(随访时间16±5)和58.82%(10/17)的持续性房颤患者(随访时间13±5)维持窦性心律,二组间窦性心律的维持率有显著差异(P<0.05)。窦性心律下房颤消融的手术时间显著短于房颤节律下的消融时间(188±30与243±26min,P<0.01)。本组有2例患者出现心包填塞,1例胸壁血肿,1例中重度肺静脉狭窄,1例急性胃扩张,总的并发症发生率为5.1%,经护理和治疗后全部康复。结论:CARTO三维标测系统指导下行射频消融治疗房颤安全有效。规范化的护理是取得良好疗效的重要保障。

Objective： To explore nursing methods and treatment of complications after catheter ablation guided by Carto mapping in patients with atrial fibrillation. Methods： Eighty-one cases of paroxysmal atrial fibrillation and seventeen cases of persistent atrial fibrillation were observed and nursed intensively after treatment.The mental nursing was conducted before the ablative procedure, and vital signs were obversed during and after the procedure, and the complications were observed and cared intensively. Results：Seventy-one patients （87.65% ,71/81） with paroxysmal atrial fibrillation were under sinus rhythm during 16 months follow-up period, ten patients （58.82%, 10/17） with persistent atrial fibrillation were also under sinus rhythm during 13 months follow-up period. The rate of atrial fibrillation-free survival between paroxysmal AF and persistent AF had significant difference （P〈O.05）. Procedural time in patients with sinus rhythm during the ablation was significantly shorter than that in patients with AF rhythm （ 188 ± 30 vs 243 ±26 min, P〈0.01 ）. Two patients suffered from cardiac tamponade, one patient from subclavical haematoma, one from serious stenosis of pulmonary vein, and one from acute dilatation of stomack. The total incidence rate of complications was 5.1%. All patients with complications were recovered under intensive nursing and treatment. Conclusion：The catheter ablation guided by Carto mapping in patients with paroxysmal and persistent AF is effective and safe and intensive and normalized care is great guarantee for optimal efficiacy.