左心耳封堵术对老年心房颤动患者预防脑卒中的临床研究

Clinical study of left atrial appendage occlusion for stroke prevention in elderly patients with atrial fibrillation

目的 评价左心耳封堵术在老年心房颤动(房颤)患者中预防脑卒中的安全性和有效性。方法 选择2019年1月至2021年12月江苏省苏北人民医院心血管内科行左心耳封堵术的老年房颤患者142例,根据年龄分为≥70岁组88例,<70岁组54例。比较2组临床资料、术中参数和并发症、抗栓治疗方案及1年随访预后的差异。结果 ≥70岁组高血压(78.4%vs 66.7%)、冠心病(70.5%vs 53.7%)、心力衰竭(29.5%vs 14.8%)、肾功能异常(14.8%vs 5.6%)、利伐沙班(54.5%vs 42.6%)、非甾体类抗炎药(69.3%vs 51.9%)比例明显高于<70岁组,男性(51.1%vs 70.4%)、饮酒(11.4%vs 27.8%)、大出血史(2.3%vs 9.3%)比例明显低于<70岁组,差异有统计学意义(P<0.01)。≥70岁组手术时间和一站式手术比例明显低于<70岁组[(136.80±102.17)min vs(171.61±115.20)min,P<0.05;10.2%vs 27.8%,P<0.01]。术中即刻食管超声心动图显示,≥70岁组少量残余分流4例,<70岁组少量残余分流1例;2组未发生死亡、假性动脉瘤、膈神经损伤、气道损伤、心房食管瘘、出血等手术安全性事件。2组各发生1例心包积液围术期并发症。随访1年,2组缺血性脑卒中、房性心律失常复发、大出血及死亡比例比较,差异无统计学意义(P>0.05)。结论 左心耳封堵术用于老年房颤患者安全可行,预防缺血性脑卒中安全有效。

Objective To evaluate the safety and efficacy of left atrial appendage occlusion(LAAO)for stroke prevention in elderly patients with atrial fibrillation(AF).Methods A total of 142 elderly AF patients undergoing LAAO in Northern Jiangsu People's Hospital from January 2019 to December 2021 were enrolled in this study.They were divided into≥70 years old group(88 patients)and 70 years old group(54 patients).The clinical data,intraoperative parameters,complications,antithrombotic regimens and 1-year prognosis during follow-up were compared between the 2 groups.Results The proportions of hypertension(78.4%vs 66.7%),coronary heart disease(70.5%vs 53.7%),heart failure(29.5%vs 14.8%),renal dysfunction(14.8%vs 5.6%),and ratios of taking rivaroxaban(54.5%vs 42.6%)and non-steroid anti-inflammatory drugs(69.3%vs 51.9%)were significantly higher,while the proportions of male(51.1%vs 70.4%),drinking(11.4%vs 27.8%)and history of major bleeding(2.3%vs 9.3%)were obviously lower in the≥70 years old group than the <70 years old group(P<0.01).Operation time and proportion of one-stop operation was statistically lower in the≥70 years old group than the other group(136.80±102.17 min vs 171.61±115.20 min,P<0.05;10.2%vs 27.8%,P<0.01).Immediate esophageal echocardiography showed that there were 4 cases of residual shunt in the≥70 years old group and 1 case in the <70 years old group.No surgical safety events such as death,pseudoaneurysm,phrenic nerve injury,airway injury,atrial esophageal fistula or hemorrhage were seen in the 2 groups.Perioperative complication,pericardial effusion occurred in 1 case in each group.After 1-year follow-up,there were no notably differences in the rates of ischemic stroke,atrial arrhythmia recurrence,massive hemorrhage and death between the two groups(P>0.05).Conclusion LAAO is safe and effective for the elderly AF patients for the prevention of ischemic stroke.