摘要
目的探讨心房颤动(房颤)患者导管消融围术期应用不间断口服达比加群酯期间出现心包压塞,穿刺引流后引流管拔除与重启抗凝的时机。方法本研究为回顾性研究,纳入北京安贞医院2019年1月至2021年8月间接受房颤导管消融,围术期应用不间断达比加群酯抗凝期间出现心包压塞的患者共20例。收集患者临床基线资料,导管消融、心包压塞与处理参数,引流管拔除、重启抗凝时间以及围术期并发症等情况。结果所有患者均顺利行心包穿刺、引流,平均引流量为(427.8±527.4)ml;7例予依达赛珠单抗治疗,其中1例行外科开胸修补术。19例未开胸患者术后拔管时间为(1.4±0.7)d,重启抗凝时间为(0.8±0.4)d;无论是否应用依达赛珠单抗,拔管时间、重启抗凝时间以及住院时间差异无统计学意义。所有患者住院期间及出院后30 d内未发生再出血、栓塞及死亡等严重并发症。结论房颤导管消融围术期应用不间断达比加群酯抗凝期间发生心包压塞时,一旦止血确切,无论是否应用特异性拮抗剂,尽早拔管与重启抗凝安全、合理。
Objective To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation(AF)suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran.Methods A total of 20 patients with pericardial tamponade,who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021,were included in this retrospective analysis.The clinical characteristics of enrolled patients,information of catheter ablation procedures,pericardial tamponade management,perioperative complications,the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed.Results All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients.The average drainage volume was(427.8±527.4)ml.Seven cases were treated with idarucizumab,of which 1 patient received surgical repair.The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was(1.4±0.7)and(0.8±0.4)days,respectively.No new bleeding,embolism and death were reported during hospitalization and within 30 days following hospital discharge.Time of removal of pericardial drainage catheter,restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not.Conclusion It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.
作者
赵欣
戴雯莉
苏鑫
吴佳慧
贾长琪
冯莉
宁曼
阮燕菲
左嵩
胡荣
杜昕
董建增
马长生
Zhao Xin;Dai Wenli;Su Xin;Wu Jiahui;Jia Changqi;Feng Li;Ning Man;Ruan Yanfei;Zuo Song;Hu Rong;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2023年第1期45-50,共6页
Chinese Journal of Cardiology
基金
国家自然科学基金(81600262,81530016,81670291,81870244)。
关键词
心房颤动
心包压塞
不间断达比加群酯
引流管拔除
抗凝重启
Atrial fibrillation
Pericardial tamponade
Uninterrupted dabigatran
Drain removal
Anticoagulation restart
