经皮左心耳封堵术临床应用及研究进展

Clinical application and advances of percutaneous left atrial appendage occlusion

心房颤动(简称房颤)是在老年人中十分常见的一种心律失常,非瓣膜病房颤患者左心房血栓90%以上存在于左心耳,风湿性瓣膜病患者60%脑卒中栓子来源于左心耳。华法林是预防房颤血栓栓塞最主要的治疗方法,但华法林可导致出血风险增加、需定期监测凝血酶原国际标准化比值、治疗窗狭窄、与其他药物及食物会出现相互反应等不良事件。而新型口服抗凝药价格昂贵,依从性不确定、漏服风险增加、缺乏拮抗剂,且部分患者对抗凝药反应较差或存在抗凝禁忌证,导致其临床应用相对不足。近年来,多项大型临床研究证实经皮左心耳封堵(percutaneous left atrial appendage occlusion,PLAAO)可以有效降低房颤患者脑卒中的发生率。本文旨在对PLAAO术的相关研究及最新进展作一综述,以期为临床提供参考。

Atrial fibrillation(Af) is a common type of arrhythmia in the elderly.More than 90% of left atrial thrombosis in non-valvular disease Af and over 60% of stoke embolus in rheumatic valvular disease occur in left atrial appendage.Warfarin is the main treatment method for preventing atrial thromboembolism.However,it may lead to increased risk of bleeding.Prothrombin international standardization ratio needs to be regularly monitored.Warfarin has narrow therapeutic window,and has interaction and adverse effects with other drugs and food.Novel oral anticoagulants are expensive,has compliance uncertainty and increased risk of leakage suit.They also lack antagonists,and some patients exist poor response to anticoagulants or anticoagulant contraindicated,lead to the relatively insufficient clinical application.In recent years,several large clinical studies confirm that percutaneous left atrial appendage occlusion(PLAAO) can effectively reduce the incidence of stroke in Af patients.This paper aims to provide a review of the research and latest development of the PLAAO.