改良的“大针套小针”干性心包穿刺术用于心外膜消融通路建立的有效性及安全性研究

Study on Effectiveness and Safety of Modified“Needle in Needle”Dry Pericardiocentesis for Epicardial Access

目的评估改良的“大针套小针”干性心包穿刺术用于心外膜消融通路建立的有效性及安全性。方法回顾性选取2012年8月—2022年1月,因心律失常就诊于四川大学华西医院心内科并采用经剑突下干性心包穿刺术行心外膜标测和消融的患者。根据心包穿刺具体方式,分为Sosa组及“大针套小针”(NIN)组,比较两种心包穿刺方式的安全性和有效性。结果本研究总计纳入患者86例,其中Sosa组13例(15.12%),NIN组73例(84.88%)。NIN法与Sosa法相比,二者在患者年龄、性别、体重指数、缺血性心肌病构成、扩张型心肌病构成、室性心动过速比例、室性期前收缩比例、左室射血分数、纽约心功能分级、β受体阻滞剂使用情况、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体内啡肽酶抑制剂使用情况、胺碘酮使用情况、植入型心律转复除颤器/心脏再同步化治疗除颤器植入方面,均无显著统计学差异;穿刺成功率二者相似(100%vs 92.3%,P=0.15);但NIN组心包穿刺总时间更少[(5.73±0.58)min vs(12.38±0.64)min,P<0.001],严重并发症发生率更低(0%vs 15.4%,P=0.02),轻微并发症发生率更低(1.4%vs 23.1%,P=0.01),X射线曝光时间更短[(1.85±0.84)min vs(3.86±1.69)min,P<0.001]。结论“大针套小针”法干性心包穿刺术,穿刺时间短,并发症发生率低,安全性及有效性均较高,有望临床进一步推广及应用。

Objective To evaluate the effectiveness and safety of modified“needle in needle”dry pericardiocentesis for epicardial access.Methods We retrospectively selected patients who were hospitalized in the department of cardiology of West China Hospital due to tachyarrhythmia and underwent epicardial mapping and ablation by trans-xiphoid dry pericardiocentesis from August 2012 to January 2022.According to the specific methods of pericardiocentesis,they were divided into Sosa group and“needle in needle”(NIN)group.And the effectiveness and safety of the two methods of pericardiocentesis were compared.Results A total of 86 patients were enrolled in this study,including 13(15.12%)in Sosa group and 73(84.88%)in NIN group.There were no significant differences in patients’age,gender,body mass index,ischemic cardiomyopathy ratio,dilated cardiomyopathy ratio,ventricular tachycardia ratio,ventricular premature beat ratio,left ventricular ejection fraction,New York Heart Association classification,βreceptor blockers ratio,angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors ratio,amiodarone ratio,implantable cardioverter defibrillator/cardiac resynchronization defibrillator implantation.The puncture success rate was similar between NIN group and Sosa group(100%vs 92.3%,P=0.15).However,in NIN group,advantages were seen in the aspects of total time of pericardiocentesis[(5.73±0.58)min vs(12.38±0.64)min,P<0.001],the incidence of serious complications(0%vs 15.4%,P=0.02)and minor complications(1.4%vs 23.1%,P=0.01),and the X-ray exposure time[(1.85±0.84)min vs(3.86±1.69)min,P<0.001].Conclusion Dry pericardiocentesis with NIN method has the advantages of shorter puncture time,lower complication rate,higher safety and effectiveness,and is expected to be further popularized and applied in clinic.