减少射频消融术中迷走神经反射发生的体会

Clinical Research on Reducing Vagal Reflex during RFCA

目的探讨射频消融术(RFCA)中及术后因迷走神经反射介导的心动过缓-低血压现象的发生机制及临床意义,分析采取8项措施,减少迷走神经反射发生的情况.方法接受RFCA的快速心律失常患者中,将早期未采取特殊处理措施的148例定为对照组,将采取防范迷走神经反射措施的1 540例定为观察组,观察组使用了8项干预措施,对照组未给任何处理.结果 RFCA过程中,心动过缓-低血压现象的发生率在对照组为13.5%(20/148),观察组为5.0%(77/1 540),P<0.01.结论 RFCA中,发生心动过缓-低血压现象由迷走神经反射介导,与导管刺激心脏,血管受压,以及血容量不足等因素有关,通过采取术前不限制饮食,术中及术后斟情快速补液和拔管后压迫止血用力适度等措施,可明显减少此现象发生.早期发现,及时处理是抢救成功的关健.

Objective To discusse the mechanism and clinical significance of bradycardia -hypotension phenomenon which is caused by vagal reflex during and after the RFCA and present the experience of using appropriate measures to decrease the incidence of this situation. Methods The patients who were suffering from tachyarrhythmias and treated by RFCA were divided into two groups. The groups were as follows：148 patients who were not taken special measures in the early stage were selected in control group;1 540 patients who were taken measures to prevent vasovagal reflex were selected in observation group. Result During the RFCA, the incidence of bradycardia -hypotension phenomenon in control group was 13.5% （20/148）, the incidence of bradycardia-hypotension phenomenon in observation group was 5.0%（77/1540） （P〈0.01） .Conclusions The incidence of bradycardia-hypotension phenomenon caused by vagal reflex during the RFCA is related to catheter irritation to the heart,pressure on the vessels and hypovolemia. The incidence of this phenomenon can be decreased obviously by some measures,such as non-restricted diet before RFCA,discretion rehydration during and after the RFCA and hemostasis with appropriate force after extubation. The key to rescue patients successfully are early detection and timely processing.