中心静脉压测量在房颤射频消融术中的应用

Measurement of central venous pressure before and after catheter ablation in atrial fibrillation patient

目的:探索中心静脉压测量在房颤射频消融术中应用的价值,尤其对于在合并心功能不全的房颤患者消融中的意义。方法:入选39例导管消融的房颤患者,平均年龄(64.4±12.6)岁。阵发性房颤24例,持续性、永久性房颤15例。心功能NYHAⅠ级17例,Ⅱ级18例,Ⅲ级4例。左室射血分数51%～77%。分别测量消融术前、术后即刻中心静脉压。结果:患者术后平均中心静脉压(12.9±4.6)cmH2O较术前平均中心静脉压(9.1±1.8)cmH2O有明显升高(P=0.000);手术前后的变化值(△CVP)在心功能Ⅲ级组(6.3±5.3)cmH2O显著高于Ⅰ级组(3.5±3.0)cmH2O和Ⅱ级组(2.3±3.2)cmH2O(P<0.05);术后中心静脉压与手术时间、放电时间的相关系数分别为0.797(P=0.010),0.675(P=0.046);消融术前后中心静脉压变化值与手术时间、放电时间的相关系数分别为0.904(P=0.001),0.806(P=0.009)。术后出现心衰症状或肺部啰音的患者,术后中心静脉压以及中心静脉变化值均明显高于无症状组和无啰音组(均P<0.05)。结论:房颤合并心功能不全患者进行射频消融术时,中心静脉压可成为术中监测的重要临床内容,不仅方法简单实用,更可以提高术中的安全性。

Objective To investigate the value of central veinous pressure measurement during the process of catheter ablation in atrial fibrillation patients, especially in patients with chronic heart failure. Methods 39 patients were enrolled [ （ 64.4 ± 12.6） yrs, LVEF （ 60.4 ±10.4） % ） ], including 24 patients with paroxysmal atrial fibrillation and 15 patients with chronic persistent atrial fibrillation. Their cardiac function levels were different （NYHA I 17cases, Ⅱ 18 cases, Ⅲ 4 cases）. All of them underwent the procedure of catheter ablation. Central venous pressure （CVP） were measured before and after the procedure. Results The CVP levels were highly increased after ablation E （9.1±1.8） cmH20 vs. （ 12.9± 4.6 ）cmH20, P = 0.000]. the variation of CVP （ACVP） in group of NYHAⅢ（6.3 ± 5.3） cmH2O] was more serious than group of NYHA Ⅰ[（3.5 ± 3.0 ）cmH2O] and Ⅱ[ （2.3 ±3.2） cmH20, P 〈 0.05 ]. The CVP of post-ablation was correlated with whole procedure time （r = 0.797, P = 0.010） and ablation time （r = 0.675,P = 0.046）. The △C VP was also correlated with the whole procedure time and the ablation time （r = 0.904,P = 0.001 ;r = 0.806,P = 0.009）. Patients with higher post-ablation CVP level and △CVP level had a higher occurrence of heart dysfunction symptoms and signs （P 〈 0.05）. Conclusions The measurement of CVP during the procedure of atrial fibrillation ablation seems very important, and it is easy and practical for the procedure. It may improve the operation safety.