经导管消融治疗心房颤动并发左锁骨下皮下血肿的分析

目的探讨经导管射频消融治疗心房颤动(简称房颤)并发左锁骨皮下血肿的原因及其预防和处理方法。方法及结果回顾性分析本科接受经导管射频消融治疗的143例房颤患者,其中有7例(0.49%)出现左锁骨下皮下血肿。7例患者中4例曾误穿左锁骨下动脉、3例曾有3次以上穿刺经历。疼痛及皮肤青紫改变是所有患者的常见症状。血常规检查中性粒细胞计数在发现血肿后即刻即明显升高,但第2天开始缓慢降低并逐渐恢复正常;而红细胞及血红蛋白在发现血肿后持续降低,平均3~4天后才停止降低趋势并逐渐回升。7例患者均出现低热反应,且与中性粒细胞水平改变一致。处理上以观察及预防性应用抗生素为主。平均住院时间较同期住院患者长1周,无1例并发感染。结论经导管射频消融治疗房颤术后并发左锁骨下皮下血肿时疼痛是早期症状,此时通过体检可以及时发现并诊断,提高穿刺技巧是预防的关键。

The diagnosis and treatment of subclavial hematoma complicated in patients undergoing transcatheter ablation of atrial fibrillation

Objective To investigate the diagnosis and treatment of subclavial hematoma complicated in patients undergoing trans-catheter ablation of atrial fibrillation(AF).Methods and Results A total of 143 AF cases treated by trans-catheter ablation were retrospectively examined,7(0.49%) of them complicated with subclavial hematoma.Inadvertent puncture of subclavial artery occurred in 4,and repeated punctures occurred in 3 cases during the procedure.Pain and ecchymosis were the common presentations in all 7 cases.Increased neutrocytes could be observed immediately after detection of the hematoma,but they tended to return to normal thereafter,while hemoglobin kept falling for 3-4 days after detection of hematoma.Low degree of fever was observed in all 7 cases,which was consistent with the abnormal changes of blood test.The treatment for hematoma included clinical observation and preventive administration of antibiotics.Conclusions Pain is the primary presentation before detection of subclavial hematoma,comprehensive examinations at this time could reveal the hematoma.Improving puncture technique can reduce this complication.[Chinese Journal of Cardiac Pacing and Electrophysiology,2006,20(1):45~46 ]