射频消融术中不同剂量肝素钠对凝血功能的干预作用

Intervention effect of different doses of heparin sodium in radiofrequency catheter ablation on coagulation function

目的探讨射频消融术(RFCA)对凝血功能的影响及不同剂量肝素钠的干预作用。方法选择2014年12月至2015年11月在湖南省人民医院心内科首次行RFCA治疗的房室结折返性心动过速患者30例,根据术中经血管鞘注射不同剂量普通肝素钠分为A组(70 U/Kg)15例和B组(100 U/Kg)15例,分别于术前、射频消融术后即刻、术后24 h、术后3 d、术后5 d、术后7 d共6个时间段采静脉血标本,立刻做血浆D-二聚体检测。结果 1组内比较:A组患者射频消融术后即刻、术后24 h和术后3 d的D-二聚体值分别为(2.280±0.081)mg/L、(0.821±0.119)mg/L、(0.485±0.119)mg/L,均明显高于术前的(0.366±0.070)mg/L,差异均有统计学意义(P<0.05),术后7 d D-二聚体值[(0.361±0.099)mg/L]恢复术前水平。B组患者射频消融术后即刻(2.191±0.074)mg/L、术后24 h(0.749±0.006)mg/L、术后3 d(0.410±0.006)mg/L的D-二聚体均较术前的(0.372±0.008)mg/L明显升高,差异均有统计学意义(P<0.05),术后5 d D-二聚体值[(0.367±0.068)mg/L]恢复术前水平。2组间比较:射频消融术后即刻、术后24 h、术后3 d、术后5 d,A组D-二聚体升高的程度明显大于B组,差异均有统计学意义(P<0.05)。结论射频消融术会影响患者D-二聚体的变化,从而影响凝血功能,有形成血栓栓塞的风险;为减少射频消融术中血栓形成的风险,推荐在术中运用100 U/Kg肝素钠。

Objective To explore the impact of radiofrequency catheter ablation(RFCA) on coagulation function and the preventive effect of different doses of heparin sodium in related patients. Methods Thirty patients with atrioventricular nodal reentrant tachycardia who underwent RFCA for the first time in the First Affiliated Hospital of Hunan Normal University from December 2014 to November 2015 were divided into two groups according to intraoperative vascular sheath injection of different doses of unfractionated heparin sodium: group A(70 U/kg, n=15), group B(100 U/kg, n=15), respectively. Venous blood samples were collected before operation, immediately after radiofrequency ablation, 24 h, 3 d, 5 d, 7 d after operation for detection of plasma D-dimer. Results 1 Within group comparison: In group A, D-dimer levels immediately after radiofrequency ablation, 24 h after operation, 3 d after operation were significantly higher than those before surgery [(2.280±0.081) mg/L,(0.821±0.119) mg/L,(0.485±0.119) mg/L vs(0.366±0.070) mg/L, P<0.05], while the D-dimer level 7 d after operation showed no statistically significant difference with that before operation [(0.361±0.099) mg/L vs(0.366±0.070) mg/L, P>0.05]; In group B, D-dimmer levels immediately after radiofrequency ablation, 24 h after operation, 3 d after operation were significantly higher than that before surgery [(2.191±0.074) mg/L,(0.749±0.006) mg/L,(0.410±0.006) mg/L vs(0.372±0.008) mg/L, P<0.05], while the level 5 d after operation showed no statistically significant difference with that before operation [(0.367 ± 0.068) mg/L vs(0.372 ± 0.008) mg/L, P>0.05]. 2 Comparison between groups: D-dimmer levels immediately after radiofrequency ablation, 24 h, 3 d, 5 d after operation in group A were significantly higher than those in group B(P<0.05). Conclusion Radiofrequency catheter ablation may affect changes in D-dimer of the patients, thereby affecting coagulation, with a risk of thrombosis embolism. To reduce the risk of thrombosis, heparin sodium at the dose of 100 U/kg is recommended during surgery.