缺血性卒中患者房间隔结构异常介入封堵术围术期管理

Perioperative Management of Transcatheter Closure of Atrial Septal Abnormalities in Patients with Ischemic Stroke

目的总结缺血性卒中合并房间隔结构异常患者进行卵圆孔未闭(patent foramen ovale,PFO)/房间隔缺损(atrial septal defect,ASD)封堵治疗围术期管理经验。方法以2015年5月-2016年5月在首都医科大学附属北京天坛医院接受房间隔结构异常封堵治疗的缺血性卒中患者为研究对象。回顾性分析患者围术期的情况,包括术前准备、围术期生命体征、术后及并发症管理等内容。比较患者术前、术中和术后的血压及心率变化。结果入组27例患者均顺利完成介入封堵术。术后随访封堵器位置良好,未见封堵器移位及表面血栓形成,无脑缺血事件复发。患者术前、术中、术后的血压无显著变化;术前、术中、术后的心率分别为(70.72±9.18)次/分、(77.48±8.69)次/分和(67.69±8.73)次/分,有显著差异(P<0.001),术中心率显著高于术前和术后(均P<0.001)。结论 PFO/ASD封堵术围术期管理有助于手术顺利进行,为降低患者术后并发症和提高手术成功率提供支持。

Objective To summarize the perioperative clinical characteristics and management experience of transcatheter closure of atrial septal abnormalities（patent foramen ovale[PFO], atrial septal defect[ASD]） in patients with ischemic stroke.Methods Ischemic stroke patients who underwent transcatheter closure of atrial septal abnormalities at Beijing Tiantan Hospital between May 2015 and May 2016 were enrolled. The blood pressure and heart rate of patients with ischemic stroke complicated with ASD before, during and after transcatheter closure of PFO/ASD were analyzed.Results Interventional occlusion was successfully performed in 27 patients. The patients were discharged in average 2 days after the operation. All patients had no symptoms and the occluder were in good position. No occluder malposition and thrombus, no neurological recurrences were observed. There were no statistically significant differences in blood pressure before, during and after treatment; there were statistically significant differences in heart rate before, during and after treatment（70.72±9.18 beats/min, 77.48±8.69 beats/min, 67.69±8.73 beats/min, P〈0.01）.Conclusion Perioperative management of transcatheter PFO or ASD closure can help to reduce postoperative complications and improve the success rate of operation.