Amplatzer封堵器在左心耳封堵术治疗出血风险性心房颤动患者中的临床疗效

Clinical Effect on Left Atrial Appendage Occlusion with the Amplatzer Cardiac Plug in Atrial Fibrillation Patients with Increased Bleeding Risk

目的:探讨Amplatzer封堵器在左心耳封堵术治疗出血风险性心房颤动患者中的临床疗效。方法:选取2013年3月至2015年5月我院心内科收治的行左心耳封堵术治疗出血风险性心房颤动患者60例作为LAAO组,另选取同期出血风险性心房颤动患者80例作为对照组。比较两组患者治疗前后血浆ANP水平、左室射血分数(LVEF)和LAA峰值排空速度,同时比较两组1年及2年期生存率。结果:LAAO组术后72h及术后3个月血浆ANP水平较术前均减少,差异有统计学意义(P<0.05);术后3个月后恢复至26.56±5.17(pg/mL),与对照组相比差异无统计学意义(P>0.05)。术后3个月两组患者心功能指标较治疗前均有改善,且观察组患者各项心功能指标改善均优于对照组,差异有统计学意义(P<0.05)。两组患者1年期(88.3%vs72.5%)及2年期(53.3%vs38.8%)生存率比较,差异有统计学意义(P<0.05)。结论:左心耳封堵术治疗出血风险性心房颤动应用Amplatzer封堵器能有效提高患者生存率,改善心脏功能,具有较好的应用前景。

Objective: To investigate the clinical effect on left atrial appendage occlusion with the amplatzer cardiac plug in atrial fibrillation patients with increased bleeding risk. Methods: 60 atrial fibrillation patients with increased bleeding risk by Left atrial appendage occlusion admitted in cardiology department of our hospital during March 2013 to May 2015 were selected as LAAO group and 80 atrial fibrillation patients with increased bleeding risk for the same period as the control group. The plasma ANP,left ventricular ejection fraction( LVEF) and LAA peak,1 year and 2 year survival rates were compared of two groups before and after treatment. Results: The plasma ANP level of LAAO Group after 72 h and 3 months postoperative were significantly decreased. After 3 months,the ANP level back to 26.56±5.17( pg/ml),there was no statistically significant difference compared with control group( P >0.05). and recovered to preoperative levels after 3 months postoperative. Compared with control group,the difference was statistically significant( P <0.05). The cardiac function index of two groups were significantly better than before treatment and the improvement of observation group was significantly better than control group,the difference was statistically significant( P <0.05). The 1 year survival rates( 88.3% vs72.5 %) and 2 year survival rates( 53.3% vs38.8 %) of two groups were significant difference( P < 0.05). Conclusion: LAAO with ACP seems to improve the combination of survival,improve heart function and has good application prospect in patients with atrial fibrillation and increased bleeding risk.