摘要
目的探讨心房颤动(房颤)导管射频消融术后并发心肌梗死后综合征的临床特征和治疗经验。方法选择2019年3月至2021年9月解放军总医院第六医学中心心血管病医学部行导管射频消融治疗的老年房颤患者174例,根据术后结果分为正常组164例,病例组10例。采集患者临床资料、炎症及免疫指标、心肺影像学变化特征,根据临床严重程度给予对症治疗。结果174例患者中,并发心肌梗死后综合征10例(5.7%)。病例组白细胞计数、C反应蛋白和白细胞介素6水平明显高于正常组[(10.1±1.8)×10^(9)/L vs(8.7±2.3)×10^(9)/L,(8.0±3.7)mg/L vs(3.3±2.2)mg/L,(87.1±72.6)ng/L vs(13.6±11.3)ng/L,P<0.05]。病例组临床表现主要为发热10例,胸闷8例,胸痛8例,呼吸困难9例,咳嗽6例,影像学提示胸腔积液8例,肺间质炎症5例,心包积液2例。给予对症治疗后2~5 d症状缓解、体温恢复正常,炎症指标恢复正常。1个月后复查影像学恢复术前状态,无严重后果。随访半年2组房颤复发率比较,无统计学差异(17.7%vs 10.0%,P>0.05)。结论房颤导管射频消融术后心肌梗死后综合征并非罕见,白细胞介素6升高是预测其发生的敏感指标,及时诊断并给予对症治疗预后良好。
Objective To explore the clinical characteristics and treatment experience of postinfarction syndrome after catheter ablation for atrial fibrillation(AF).Methods A total of 174 elderly AF patients receiving radiofrequency catheter ablation in our department from March 2019 to September 2021 were recruited in this study.According to the occurrence of post-infarction syndrome or not,they were divided to normal group(n=164)and case group(n=10).Clinical data,inflammatory and immune indicators,cardiopulmonary images and other characteristics of patients were collected,and symptomatic treatment such as non-steroidal anti-inflammatory drugs was given according to the severity.Results Post-infarction syndrome occurred in 10 patients(5.7%).The postoperative white blood cell count and levels of CRP and IL-6 were significantly higher in the case group than the normal group[(10.1±1.8)×10^(9)/L vs(8.7±2.3)×10^(9)/L,(8.0±3.7)mg/L vs(3.3±2.2)mg/L,(87.1±72.6)ng/L vs(13.6±11.3)ng/L,P<0.05].In the case group,the main clinical manifestations were fever(10 cases),chest tightness(8 cases),chest pain(8 cases),dyspnea(9 cases),cough(6 cases),presence of pleural effusion on images(8 cases),interstitial inflammation(5 cases),and pericardial effusion(2 cases).Within 2-5 d after symptomatic treatments were given,these symptoms were relieved,body temperature returned to normal,and inflammatory indicators returned to normal on re-examination.In 1 month later,the imaging findings returned to the preoperative status,without serious consequences.After 6 months of follow-up,there was no significant difference in the recurrence rate of AF between the two groups(17.7%vs 10.0%,P>0.05).Conclusion Post-infarction syndrome is not rare after catheter ablation of AF,and IL-6 elevation is a sensitive indicator to predict its occurrence.Timely diagnosis and symptomatic treatment have a good prognosis.
作者
李世兴
时向民
李健
张闯
王浩
Li Shixing;Shi Xiangmin;Li Jian;Zhang Chuang;Wang Hao(Department of Cardiovascular Diseases,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2022年第11期1128-1131,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
军队保健专项科研课题(18BJZ40)
军队医学科研项目(17QNP035)。
关键词
心房颤动
导管消融术
心肌梗死
白细胞计数
C反应蛋白质
白细胞介素6
抗菌药
atrial fibrillation
catheter ablation
myocardial infarction
leukocyte count
C-reactive protein
interleukin-6
anti-bacterial agents
