冷冻球囊消融与左心耳封堵联合治疗对心房颤动患者的影响及相关分析

Effect of Cryoballoon Ablation Combined with Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation and Related Analysis

目的 对比冷冻球囊消融与左心耳封堵联合治疗对心房颤动患者的影响,并对各指标进行相关分析。方法 选取合肥高新心血管病医院2018年1月至2020年12月收治的心房颤动患者60例作为研究对象,根据入院时间不同将其随机分为研究组和对照组,各30例,其中对照组仅给予第二代冷冻球囊消融术,研究组在此基础上联用左心耳封堵术;对比两组患者手术成功率,围术期并发症,随访情况(心房颤动复发率、血栓栓塞、缺血性脑卒中和出血发生率);对比两组围术期(术前、术后即刻、术后24 h)外周血超敏肌钙蛋白T(high-sensitivity troponin T,hs-TnT)、超敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)和D-二聚体(D-Dimer,D-D)浓度的变化;并用Spearman进行相关分析。结果 研究组和对照组患者的手术成功率、围术期各并发症及总发生率比较,差异均无统计学意义(P>0.05)。研究组和对照组患者的心房颤动复发率和出血发生率比较,差异均无统计学意义(P>0.05)。但对照组患者血栓栓塞和脑卒中发生率明显高于研究组,且差异均有统计学意义(P<0.05)。研究组和对照组患者的术前、术后即刻和术后24 h外周血hs-TnI和hs-CRP浓度比较,差异无统计学意义(P>0.05);但两组不同时间点外周血D-D浓度比较,差异有统计学意义(P<0.05)。经Spearman相关分析得知,hs-TnI、hs-CRP与心房颤动复发率呈明显正相关(P<0.05),其相关系数分别为0.721、0.689,D-D与血栓栓塞和脑卒中呈明显正相关(P<0.05),其相关系数分别为0.655、0.718。结论 与单独使用冷冻球囊消融治疗心房颤动比较,联合左心耳封堵术虽不能提高3个月内手术成功率,但也不增加围术期并发症发生率,且可明显降低远期血栓栓塞和脑卒中发生率,与外周血D-D浓度变化有关。

Objectives To compare the effects of cryoballoon ablation combined with left atrial appendage occlusion in patients with atrial fibrillation,and to analyze the correlation of each index.Methods From January 2018 to December 2020,60 patients with atrial fibrillation in Hefei High-tech Cardiovascular Hospital were randomly divided into study group and control group according to the time of admission,30 cases in each group.The success rate of operation,perioperative complications and follow-up(recurrence rate of atrial fibrillation,thromboembolism,ischemic stroke and hemorrhage)were compared between the two groups.The changes of concentrations of high-sensitivity troponin I(hs-TnI),highsensitivity C-reactive protein(hs-CRP)and D-Dimer(D-D)in peripheral blood were compared between the two groups during the perioperative period(before operation,immediately after operation and 24 h after operation).Spearman was used for correlation analysis.Results There were no significant differences in the success rate of operation,perioperative complications and total incidence between the two groups(P>0.05).There were no significant differences in the recurrence rate of atrial fibrillation and the incidence of bleeding between study group and control group(P>0.05).However,the incidences of thromboembolism and stroke in control group were significantly higher than those in study group,and the differences were statistically significant(P<0.05).There were no significant differences of concentrations of hs-TnI and hs-CRP between the two groups(P>0.05);however,there was significant difference of concentration of peripheralblood D-D between the two groups at different time points(P<0.05). Spearman correlation analysis showed that hs-TnIand hs-CRP significantly positively correlated with the recurrence rate of atrial fibrillation(P<0.05),and the correlationcoefficients were 0.721 and 0.689 respectively. D-D significantly positively correlated with thromboembolism and stroke(P<0.05),and the correlation coefficients were 0.655 and 0.718 respectively. Conclusions Compared with single use ofcryoballoon ablation in the treatment of patients with atrial fibrillation,combining with left atrial appendage occlusion cannot improve the success rate within 3 months,but also does not increase the incidence of perioperative complications,and can significantly reduce the incidence of long-term thromboembolism and stroke,which is related to the change ofconcentration of peripheral blood D-D.