射频消融术延迟血栓形成及低分子肝素的防治

目的探讨射频导管消融术(RFCA)延迟血栓形成的发生机制及防治对策。方法选取48例行RFCA患者为治疗组和21例行心内电生理检查(EPS)患者为对照组。治疗组随机分为两亚组,A组23例术后不予肝素,B组25例术后运用低分子肝素,A组以肝细胞生长因子(HGF)0.4ng/ml为界分为高HGF组和正常HGF组。在不同时间测定凝血酶-抗凝血酶Ⅲ复合物(TAT)及HGF。结果①A组TAT呈现两次高峰:术后即刻第一次高峰(42.9±15.8ng/ml),术后3天第二次高峰(20.3±19.2ng/ml),第二次高峰与EPS组术后3天(2.7±1.7ng/ml)及B组术后3天(4.3±5.3ng/ml)比较差异有显著性(P<0.05);②A组术后6hHGF值与TAT两次高峰相关(r=0.542,P<0.01);术后6h高HGF组TAT术后3天高峰更显著。结论RFCA致血栓形成可分两阶段:术后即刻的急性阶段和术后3天的延迟阶段。术后肝素化可影响凝血系统,有阻止血栓形成的效果。

Delayed thrombogenesis following radiofrequency catheter ablation and prophylactic therapy of low molecular weight heparin

Objective To investigate the pathogenesis and prophylactic therapy of delayed thrombogenesis caused by radiofrequency catheter ablation (RFCA). Methods Blood samples were collected at 6 different times to measure the thrombin-antithrombin Ⅲ complex (TAT) and hepatocyte growth factor (HGF)in 48 patients who underwent RFCA and in 21 control subjects who underwent electrophysiologic study(EPS).48 patients were divided into 2 groups randomly, and low molecular weight heparin was given to 25 cases (subgroup B) after RFCA,but not to the others (subgroup A). Results ①Plasma TAT exhibited a double peaked pattern in the subgroup A: the first peak occurred instantly after RFCA(42.9±15.8 ng/ml), and the second peak at 3 days later(20.3±19.2 ng/ml). The second peak was significantly higher than that of the control group (2.7±1.7 ng/ml)and the subgroup B(4.3±5.3 ng/ml)(P<0.05). ②The HGF in the subgroup A obtained 6 hours after RFCA was in relation to the double peak of TAT(r=0.542,P<0.01);The HGF high group(HGF≥0.4 ng/ml,n=7)exhibited a high significantly second peak at 3 days after RFCA. Conclusion Thrombogenesis caused by RFCA has 2 phases: the acute phase at instantly after the procedure and the delayed phase at 3 days later. Subcutaneous low molecular weight heparin after RFCA can influence coagulation system and prevent thrombosis.