| 摘要: |
| 目的 根据非瓣膜性房颤患者在经皮左心耳封堵术（LAAC）术前、术中及术后的超声心动图检查结果，对LAAC的并发症及其引起的心腔大小及心功能改变情况进行评估，探讨超声心动图在LAAC术中的应用价值。方法 对我院在2014年8月至2018年7月间施行的205例LAAC术前、术中和术后的超声心动图（含经胸超声心动图（TTE）及经食道超声心动图（TEE））图像及数据进行回顾性分析，对患者并发症发生情况进行汇总。分别采集LAAC术前、术后48小时、术后3至6个月、术后1年患者收缩末期左心房前后径（LAD）、舒张末期左心室前后径（LVDd）、收缩末期右心房横径（RAT）、舒张末期右心室前后径（RVD）、左室射血分数（LVEF）、左室缩短分数（LVFS）、舒张末期容积（EDV）及每搏输出量（SV），分析相应参数之间的差异。结果 超声心动图提示，成功完成LAAC 202例（98.5%，202/205），术后封堵器相关血栓（DRT）形成17例（8.4%，17/202），心包积液4例（2.0%，4/202），封堵器周边残余分流29例（14.4%，29/202，均<5mm），所有患者均未发生封堵器脱落和移位。与术前相比，术后48小时LVEF、LVFS、SV稍增高，差异有统计学意义（P<0.05）；术后3至6个月及术后1年心腔大小及心功能数据与术前相比均无统计学差异（P>0.05）。结论 LAAC作为一种预防非瓣膜性房颤患者血栓栓塞的手段是安全的，术后并发症发生率较低，且并未对心腔大小及心功能产生较大的影响。超声心动图作为LAAC安全性的评估手段具有重要的应用价值。 |
| 关键词: 超声心动图 左心耳封堵术 非瓣膜性房颤 并发症 心功能改变 |
| DOI： |
| 投稿时间：2019-06-14修订日期：2019-08-12 |
| 基金项目:超声造影定量分析仪的研究 |
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| Application of echocardiography in left atrial appendage occlusion in patients with non-valvular atrial fibrillation |
| ZHANG Anxin,GUO Yanli |
| (Department of Ultrasound,the First Affiliated Hospital of Army Military Medical University) |
| Abstract: |
| ABSTRACT Objective According to the results of echocardiography before, during and after percutaneous left atrial appendage (LAAC) in patients with non-valvular atrial fibrillation, the complications of LAAC and the changes in cardiac chamber size and cardiac function, to evaluate the value of echocardiography in LAAC. Methods Preoperative, intraoperative, and postoperative echocardiography (including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE)) of 205 LAAC performed between August 2014 and July 2018 in our hospital. The images and data were retrospectively analyzed to summarize the occurrence of complications in patients. The end systolic left atrial anteroposterior diameter (LAD)、left ventricular end-diastolic diameter (LVDd), right atrial transverse diameter (RAT), right ventricular internal diameter (RVD), left ventricular ejection fraction (LVEF), left ventricular shortening score (LVFS), end diastolic volume (EDV) and stroke volume (SV) were collected and analyzed the difference between the corresponding parameters before and 48 hours after surgery, 3 to 6 months after surgery, and 1 year after surgery. Results Echocardiography showed successful completion of LAAC in 202 patients (98.5%, 202/205), postoperative occluder-related thrombosis (DRT) in 17 patients (8.4%, 17/202), and pericardial effusion in 4 patients (2.0%, 4/202), 29 cases (14.4%, 29/202, both <5mm) had residual shunt around the occluder. No occluder detachment and displacement occurred in all patients. Compared with preoperative, LVEF, LVFS and SV increased slightly at 48 hours after operation, the difference was statistically significant (P<0.05). LAD, RAT, RVD, LVDd, LVEF, LVFS, EDV and SV was not significantly different from those before surgery (P>0.05) at 3 to 6 months after operation and 1 year after operation. Conclusions LAAC as a means of preventing thromboembolism in patients with non-valvular atrial fibrillation is safe, the incidence of postoperative complications is low, and it does not have a significant impact on cardiac size and cardiac function. Echocardiography has important application value as a means of assessing LAAC safety. |
| Key words: echocardiography left atrial appendage occlusion non-valvular atrial fibrillation complications cardiac function change |
