导管射频消融术联合左心耳封堵术在老年心房颤动患者治疗中的应用价值

The Application Value of Radiofrequency Catheter Ablation and Left Atrial Appendage Occlusion in the Treatment of Elderly Patients with Atrial Fibrillation

目的:探讨导管射频消融术联合左心耳封堵术在老年心房颤动(AF)患者中的治疗效果。方法:选取2020年5月—2023年5月黔南州人民医院收治的86例老年AF患者,按随机数字表法将其分为两组,各43例。对照组行导管射频消融术治疗,观察组加用左心耳封堵术治疗。比较两组心房率变化、心功能指标、血清学指标、凝血功能、生活质量、栓塞事件及出血事件。结果:术后3个月,观察组心房率(70.52±6.32)次/min,低于对照组的(78.54±6.74)次/min,左房内径(LAD)、左室舒张末期内径(LVEDD)分别为(31.74±3.15)、(41.02±4.13)mm,均短于对照组的(34.69±3.23)、(45.69±4.22)mm,左室射血分数(LVEF)为(58.96±5.74)%,高于对照组的(53.67±5.48)%,差异均有统计学意义(P<0.05)。术后3个月,观察组D-二聚体(D-D)、N末端B型利钠肽前体(NT-proBNP)水平分别为(124.73±10.41)ng/mL、(812.74±85.43)pg/mL,均低于对照组的(140.85±12.53)ng/mL、(906.62±91.52)pg/mL,差异均有统计学意义(P<0.05)。术后3个月,观察组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)分别为(35.65±3.25)、(13.12±1.25)、(20.49±1.75)s,均长于对照组的(31.72±3.12)、(12.25±1.16)、(17.52±1.48)s,纤维蛋白原(FIB)为(2.33±0.32)g/L,低于对照组的(2.85±0.34)g/L,差异均有统计学意义(P<0.05)。术后3个月,观察组生活质量各领域评分别为(86.57±5.47)、(85.74±5.32)、(88.63±5.24)、(89.63±5.18)分,均高于对照组的(80.13±5.35)、(79.65±5.27)、(81.69±5.15)、(82.04±5.22)分,差异均有统计学意义(P<0.05)。观察组栓塞事件、出血事件发生率均低于对照组,差异有统计学意义(P<0.05)。结论:导管射频消融术联合左心耳封堵术可提高老年AF治疗效果,稳定心房率水平,加快心功能恢复,且可改善凝血功能,降低栓塞事件及出血事件风险。

Objective:To investigate the therapeutic effect of radiofrequency catheter ablation and left atrial appendage occlusion in elderly patients with atrial fibrillation(AF).Method:A total of 86 elderly AF patients admitted to the People's Hospital of Qiannan from May 2020 to May 2023 were selected,and were divided into two groups by random number table method,with 43 cases in each group.The control group underwent radiofrequency catheter ablation,and the observation group added left atrial appendage occlusion.The atrial rate changes,cardiac function indicators,serological indicators,coagulation function,quality of life,embolic events and bleeding events were compared between the two groups.Result:At 3 months after surgery,the atrial rate in the observation group was(70.52±6.32)beats/min,which was lower than(78.54±6.74)beats/min in the control group,the left atrial diameter(LAD)and left ventricular end diastolic diameter(LVEDD)were(31.74±3.15)mm and(41.02±4.13)mm,which were shorter than(34.69±3.23)mm and(45.69±4.22)mm in the control group,the left ventricular ejection fraction(LVEF)was(58.96±5.74)%,which was higher than(53.67±5.48)%in the control group,the differences were statistically significant(P<0.05).At 3 months after surgery,the levels of D-dimer(D-D)and N-terminaltype B natriuretic peptide precursor(NT-proBNP)were(124.73±10.41)ng/mL and(812.74±85.43)pg/mL,which were lower than(140.85±12.53)ng/mL and(906.62±91.52)pg/mL in the control group,the differences were statistically significant(P<0.05).At 3 months after surgery,the activated partial thromboplastin time(APTT),prothrombin time(PT),and thrombin time(TT)of the observation group were(35.65±3.25)s,(13.12±1.25)s,and(20.49±1.75)s,which were longer than(31.72±3.12)s,(12.25±1.16)s,and(17.52±1.48)s in the control group,the fibrinogen(FIB)was(2.33±0.32)g/L,which was lower than(2.85±0.34)g/L in the control group,the differences were statistically significant(P<0.05).At 3 months after surgery,the quality of life scores in various areas of the observation group were(86.57±5.47)points,(85.74±5.32)points,(88.63±5.24)points,and(89.63±5.18)points,which were higher than(80.13±5.35)points,(79.65±5.27)points,(81.69±5.15)points,and(82.04±5.22)points of the control group,the differences were statistically significant(P<0.05).The incidences of embolic events and bleeding events in the observation group were lower than those in the control group(P<0.05).Conclusion:Combined with radiofrequency catheter ablation and left atrial appendage occlusion can improve the treatment effect of elderly AF,stabilize atrial rate level,accelerate cardiac function recovery,improve coagulation function,and reduce the risk of embolic events and bleeding events.