心房颤动射频消融术后并发急性肺水肿临床诊治研究

Clinical analysis of acute pulmonary edema after radiofrequency ablation for atrial fibrillation

目的分析心房颤动(简称房颤)射频消融术后并发急性肺水肿的特点及其处理策略。方法回顾性分析2006年8月至2008年3月浙江大学医学院附属邵逸夫医院心内科175例房颤患者;前瞻性地观察2008年4月至2009年6月该院224例房颤患者,控制消融术中净进量不超过1800 mL,术后即刻进行相应实验室及影像学检查。观察术后并发肺水肿的特点。结果控制术中进出量后,术后肺水肿发生率由3.43%(6/175)下降至1.34%(3/224),相对危险度为0.39(95%C I 0.10～1.54)。肺水肿患者经无创机械通气和利尿剂为基础的综合治疗后痊愈出院,随访6个月无不良心脏事件发生。肺水肿患者术后肌钙蛋白I峰值、中性粒细胞计数、高敏C反应蛋白同组未发生肺水肿患者明显增高(P<0.05)。结论房颤术后并发的肺水肿可能与全身炎症性反应导致的肺损伤相关,尽早使用无创机械通气及利尿剂是治疗的关键,而术中控制液体进出量可降低其发生率。

Objective To summarize the characteristics and treatment strategy of acute pulmonary edema after with radiofrequency ablation for atrial fibrillation.Methods A cohort of 175 patients treated in Department of Cardiology,Affiliated Sir Shaw Run Run Hospital of Zhejiang University Medical School between August 2006 and March 2008 were retrospectively analyzed.Another cohort of 224 patients were prospectively studied between April 2008 and June,2009.In the second group,the net fluid input was controlled below 1800 mL during the ablation.Laboratory investigations and image studies were performed immediately after operation.Characteristics of post-ablation acute pulmonary edema were evaluated.Results Controlled input during the procedure resulted in reduced incidence of acute pulmonary edema from 3.43%（6/175） to 1.34%（3/224）（RR 0.39,95%CI 0.10～1.45）.All patients with pulmonary edema were discharged home after complete recovery with integrated therapy based on noninvasive ventilation（NIV） and diuretics.No adverse cardiac events were reported during the 6-month follow-up.Elevated levels of troponin-I,neutrophil counts and high sensitive C-reactive protein were identified in those who had post-procedural pulmonary edema as compared with those who had not（P〈0.05）.Conclusion Pulmonary edema after atrial fibrillation ablation may be related to acute lung injury induced by systemic inflammations.Early use of NIV and diuretics can be critical for treatment.Controlled fluid input during the procedure may reduce the incidence of pulmonary edema.