射频消融术对凝血系统的影响

Effects of radiofrequency catheter ablation in coagulation system

目的 探讨射频消融术 (RFCA)后外周血管栓塞的发生机制及防治对策。方法 将 90例室上性心动过速患者分为 3组 :A组术前不用抗凝药 ,B组术前使用阿司匹林 ,C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、RFCA后即刻及术后 2d ,抽静脉血观察血小板α 颗粒膜糖蛋白 (Gmp 140 )、血栓烷B2 (TXB2 )、蛋白C、蛋白S的变化。结果 A组病人 ,与术前比较 ,其他 3个时段血浆Gmp 140、TXB2 含量明显增加 ,蛋白C及蛋白S血浆含量无明显变化 ,且发现左右心导管操作对Gmp 140、TXB2 变化无明显影响 ;B、C组病人与A组相比 ,相同时段的血浆Gmp 140、TXB2 含量减小。结论 RFCA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 ,服用阿司匹林及氨氯地平可阻止血小板的激活 ,有阻止血栓形成的作用。

Objective To investigate the pathogenesis and prophylactic therapy of perpheral vascular embolism after radiofrequency catheter ablation (RFCA). Method 90 patients with supraventricular tachycardia (SVT) were divided into 3 groups. Group A did not use any anticoagulant before RFCA and group B used aspirin(ASA) before RFCA, group C used calcium channel blocker amlodipine before RFCA.Blood samples were taken at 4 time points,i.e.before and after electrophysiologic examination, immediately after RFCA and 2 days after RFCA .For each blood example, blood levels of platelet alpha granule membrane glycoprotein 140 (Gmp 140)?thromboxane B 2 (TXB 2)?protein C (PC)?protein S (PS) were measured. Result In group A,Gmp 140 and TXB 2 of the blood examples taken before electrophysiologic examination were significantly lower than those taken at the three other time points, but there was no signifant change of PC and PS as compared with that at the three other time points. Ablation either on the left or right heart did not affect the levels of Gmp 140 and TXB 2; In group B and group C ,the levels of Gmp 140 and TXB 2 of the samples were significantly lower than those of the corresponding points in group A. Conclusion It is indicated that platelet aggrregability may be introduced by RFCA, but evolution of the anticoagulant system was not caused by RFCA, This may enhance the occurrence of thrombosis. ASA and amlodipine may prevent the occurrence of thrombosis.