心房颤动患者术中胃镜检查评估射频导管消融术对食管损伤的价值

The Value of Intraoperative Gastroscopy in Assessing Radiofrequency Catheter Ablation for Esophageal Injury in Patients with Atrial Fibrillation

目的探讨心房颤动患者术中胃镜检查评估射频消融术对食管损伤的价值。方法对2019年3月至2020年4月在武汉亚心总医院受射频消融术的99例心房颤动患者的手术治疗情况进行统计分析。采用双侧肺静脉前庭电隔离术进行消融,术中行胃镜监测。对于术中发现发生食管损伤的患者采取食管机械移位、消融能量限制等干预。术后24 h内对患者胸痛进行疼痛数字评分(NRS),并分析NRS评分与食管损伤的相关性。对于术中胃镜检查证实有食管损伤的患者给予温流质饮食2周,质子泵抑制剂等胃黏膜保护剂药物治疗。采用HAS-BLED评分评估出血风险,术后随访1年,观察出血不良等事件的发生情况。结果消融术中发生食管损伤17例,发生率为17%,其中局部充血6例,红斑5例,血肿6例。NRS评分:0分54例,1分15例,2分11例,3分9例,4分2例,5分5例,6分2例,7分1例,胸痛NRS评分与食管损伤程度成正相关(rs=0.682,P<0.01);出血事件主要发生在HAS-BLED评分≥3分的人群。结论射频消融术中胃镜监测和干预可降低射频消融术对食管进一步损伤风险,胸痛NRS评分与食管损伤程度成正相关,结合HAS-BLED评分可降低抗凝药物治疗的出血风险。

Objective To evaluate the value of intraoperative gastroscopy in assessing radiofrequency catheter ablation for esophageal injury in patients with atrial fibrillation.Methods A statistical analysis of the treatment status of 99 patients with atrial fibrillation who underwent radiofrequency ablation at Wuhan Yaxin General Hospital from March 2019 to April 2020.Oesophagus endoscopy was performed during radiofrequency ablation of atrial fibrillation to observe the esophageal mucosa injury.The numerical rating scale(NRS)was performed on chest pain of those patients within 24 h after operation,between NRS score and esophagus injury was analyzed.For those patients with esophageal injury found during the operation,intervention measures such as mechanical displacement of the esophagus and limitation of ablation energy were taken.so as to reduce the further esophagus injury.2-week arm liquid diet and aproton-pump inhibitor were applied to the patients if esophageal mucoasa injury were confirmed.The risk of bleeding was assessed by HAS-BLED score.Following up for 1 year,the occurrence of adverse events was observed.Results Esophagus injury was found in 17 patients via the gastroscope during radiofrequency ablation.The occurrence rate of esophagus injury was 17%.Among them,the occurrence rate of esophagus injury subclass was as follows:local hyperemia was 6.1%(6/99),erythema was 5.1%(5/99),hematoma was 6.1%(6/99).NRS grade was as follows:0 point in 54 cases,1 point in 15,2 points in 11,3 points in 9,4 points in 2,5 points in 5,6 points in 2,7 points in 1.There was a positive relationship between NRS grade and esophagus injury(rs=0.682,P<0.01);During the following-up period,bleeding events mainly occurred in group with HAS-BLED score system over 3 points.Conclusion Endoscopic monitoring and intervention during radiofrequency ablation can reduce the risk of further esophageal injury.There is a positive correlation between NRS grade of chest pain and esophagus injury.Combining HAS-BLED score can reduce the risk of bleeding in anticoagulant treatment.