非深度镇静下心房颤动冷冻球囊消融的疗效及安全性

The efficiency and safety in patients undergoing cryoballoon ablation for atrial fibrillation without deep sedation

目的总结非深度镇静下冷冻球囊消融(CBA)治疗心房颤动(房颤)的疗效及安全性。方法回顾性分析北部战区总医院2017年1-12月行CBA的259例房颤患者,其中深度镇静组应用咪达唑仑及枸橼酸芬太尼深度镇静156例,非深度镇静组103例。结果深度镇静组患者达到理想深度镇静效果的患者112例(71.8%),从给药到深度镇静状态时间(17.3±5.9)min。两组患者术中平均收缩压比较,差异无统计学意义(P>0.05)。深度镇静组患者术中平均舒张压[(83.9±13.8)mmHg比(88.0±14.5)mmHg,P=0.035,1mmHg=0.133kPa]及平均心率[(70.9±9.8)次/分比(77.0±14.7)次/分,P=0.026]均低于非深度镇静组,差异均有统计学意义。两组患者迷走神经反射发生率及术中咳嗽,恶心、呕吐,疼痛(包括头痛、胸痛或头痛合并胸痛)发生率比较,差异均无统计学意义(均P>0.05)。深度镇静组肢体移动发生率高于非深度镇静组(8.3%比1.9%,P=0.031)。两组患者手术时间及曝光量比较,差异均无统计学意义(均P>0.05)。结论CBA治疗房颤时,术中肺静脉电位隔离均成功。非深度镇静并未增加患者疼痛发生率,清醒患者可将疼痛刺激及不适症状及时反馈给术者,有利于降低并发症的发生率。

Objective To summarize the effi ciency and safety in patients undergoing cryoballoon ablation(CBA)for atrial fibrillation(AF)without deep sedation.Methods A total of 259 patients (156 with deep sedation using midazolam and fentanyl and 103 without deep sedation) undergoing CBA for AF between January 2017 and December 2017 from Shenyang General Hospital were analyzed retrospectively. Results Among the 156 patients received deep sedation, stable unconscious sedation was achieved in 112(71.8%,112/156)patients.The average time from administration to stable unconscious sedation was (17.3±5.9)min.The average diastolic blood pressure[(83.9±13.8) mmHg vs.(88.0±14.5) mmHg, P =0.035,1 mmHg=0.133 kPa]and heart rate[(70.9±9.8)bpm vs.(77.0±14.7)bpm, P =0.026] in patients with deep sedation were both lower compared with those in patients without deep sedation.The incidence of vagus reflex,cough,nausea,vomit and pain (including headache, chest pain or headache concomitant with chest pain)during the procedure had no statistical diff erence between the two groups.The limbs movements were more often observed in patients with deep sedation than those without deep sedation (8.3% vs.1.9%, P =0.031).The procedure time and radiation exposure had no statistical diff erence between the two groups.Conclusions The success rate of electrical isolation of pulmonary veins during CBA for AF was 100%.The occurrence rate of pain didn’t increase in patients without deep sedation.Complications could be reduced when conscious patients informed doctors of their pain and discomfort in time.