心脏射频消融术中心包压塞的临床诊治特点分析

目的：探讨心脏射频消融术中心包压塞的临床特点以及诊治过程。方法：对射频消融术中出现心包压塞的21例病例的病历资料及填塞时临床表现、诊断和处理、预后情况等进行回顾性分析，分析出现心包压塞患者的临床特点。结果：随着术者学习曲线的延伸，房颤和室性心律失常术中心包压塞发生率逐渐减低；女性患者心包压塞的发生率高于男性(5.4‰ vs.1.2‰，P<0.05)，尤其在室性心律失常的射频中更为明显(9.0‰ vs.1.2‰，P<0.05)；射频消融患者中，心包压塞患者年龄可能更大，尤其是室性心律失常患者中(P<0.05)；心包压塞发生时，最先出现的、容易观察到的临床表现多为心率加快和血压下降(76.2%)；心包压塞患者中，穿刺引流后痊愈者平均出血量(297.6±270.7) mL，需行外科手术患者的平均出血量更多，为(1570.0±720.5) mL (P<0.05)。结论：射频消融术中心包压塞的发生与学习曲线、性别、年龄均相关，应通过临床表现、X线透视等及早发现心包压塞并及时治疗。

Characteristics of diagnosis and treatment of tamponade of catheter ablation for arrhythmias

Objective: To analyze the incidence, predictors, clinical characteristics and prognosis of tamponade occurred in RFCA.Methods: The characteristics, clinical manifestations, diagnosis, treatment and prognosis were retrospectively analyzed in 21 (0.33%) patients who suffered from tamponade.Results:Incidences of tamponade for ablation of AF, ventricular arrhythmias (Vas) decreased over time with the extending learning curve of doctor. Incidence rate of tamponade in female was signiifcantly higher than in male (5.4‰ vs. 1.2‰,P<0.05), especially for Vas ablation (9.0‰ vs. 1.2‰,P<0.05). Advanced age was signiifcantly associated with tamponade, especially for Vas ablation (P<0.05). hTe ifrst and easy-to-observe sign which indicated tamponade is accelerated heart rate and decrease in blood pressure. hTe average amount of bleeding in tamponade patients was (297.6±270.7) mL,
which is higher in patients who undergoing surgical repair, (1 570.0±720.5) mL (P<0.05).Conclusion: Female, advanced age and learning curve were all related with tamponade in ablation, which should be observed carefully by clinical manifestations and X-ray examination and be timely treated.