射频消融术对凝血的影响及氨氯地平对其防治效果

Effect of RFCA to coagulation and prophylactic therapy of amlodipine

目的 :探讨射频消融 (RFCA)术后外周血管栓塞的发生机制及防治对策。方法 :将 6 0例室上性心动过速患者分为 2组 (A组术前不用抗凝药 ,B组术前使用钙通道阻滞剂——氨氯地平 ) ,在术前、插管完成心内电生理检测后 ,消融完成后即刻及术后 2 d,采静脉血观察血小板 α-颗粒膜糖蛋白 (Gm p- 140 )、血栓烷 B2 (Tx B2 )、蛋白C(PC)、蛋白 S(PS)的变化。结果 :A组患者与术前比较 ,其他三个时点血浆 Gmp- 140、Tx B2 含量明显增加 ,PC及PS血浆含量无变化 ,且发现年龄、血压、血脂 ,左右心系统操作对 Gmp- 140、Tx B2 变化无影响 ;B组患者与术前相比 ,其他三个时点的血浆 Gmp- 140、Tx B2 含量无明显变化。结论 :RFCA术可引起血小板的激活 ,抗凝系统无明显变化 ,可能致血栓形成 ,服用氨氯地平可阻止血小板的激活 ,有阻止血栓形成的效果。

Objective:To investigate the pathogenesis and prophylactic therapy of perpheral vasculav embolism after radiofrequency cather ablation (RFCA).Method:60 patients with supraventricular tachycardia were performed intracardial electrophysiological examination;and were divided into 2 groups:group A didn′t use anticoagulant before RFCA,group B used calcium channel blocker (amlodipine) before RFCA.Blood samples wree taken at 4 time points,i.e.before electrophysiologic examination (time point Ⅰ) and after it (Ⅱ),immediately after RFCA (Ⅲ) and 2 days after RFCA (Ⅳ).For each blood sample,blood levels of platelet α-granule membrane glycoprotein-140 (Gmp-140),thromboxane B 2 (TxB 2) protein C (PC) and prolein S (PS) were measured.Result:In group A,Gmp-140 and TxB 2 of blood sample taken at time-point 1 were signifcantly lower than those taken at other three time-point,but there was no signifant chamge of PC and PS as compared with those of other three time point;and age,blood pressure,blood lipid,ablation either on the left or right heart didn′t effect the levels of Gmp-140 and TxB 2.In growp B,levels of Gmp-140 and of TxB 2 of the sample taken after RFCA had no significant change as compared with those before RFCA.Conclusion:It suggests that platelet aggregability may be introduced by RFCA,and enhances thrombosis,while calcium cannel blocker——amlodipine may prevent thrombosis.