Page 88 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第9期
·1354 · Journal of Nanjing Medical University（Natural Sciences） 2021年9月

·临床研究·

左心耳封堵术在非瓣膜性心房颤动合并冠心病患者中的安全

性及有效性分析

蒋晓敏，罗 杰，谢渡江，周 陵，林 松，张 娟 *
南京医科大学附属南京医院心血管内科，江苏 南京 210006

［摘 要］ 目的：评估左心耳封堵术在非瓣膜性心房颤动（nonvalvular atrial fibrillation，NVAF）合并冠心病患者中的安全性及
有效性。方法：回顾分析在2015年6月—2017年7月在南京医科大学附属南京医院接受左心耳封堵术的NVAF患者51例，将
其分为两组：合并冠心病组以及未合并冠心病组，进行食道超声检查及电话随访。同时纳入同期20例接受新型口服抗凝药预
防栓塞的 NVAF 合并冠心病患者为对照。结果：NVAF 合并冠心病组（n=15）较未合并冠心病组（n=36）的栓塞及出血风险更
高，但随访结果显示两组终点事件无明显差异。与长期接受药物抗凝的冠心病患者相比，接受左心耳封堵术明显降低大出血
风险。中度及重度的左房自显影与终点事件密切相关。结论：不论是否合并有冠心病，左心耳封堵术在非瓣膜性心房颤动患
者中均可预防栓塞并降低大出血发生。左房自显影是非瓣膜性心房颤动合并冠心病患者左心耳封堵术预后的预测因子。
［关键词］ 非瓣膜性心房颤动；冠心病；左心耳封堵术；左心房自显影
+
［中图分类号］ R541.7 5 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）09⁃1354⁃08
doi：10.7655/NYDXBNS20210913

Safety and efficacy of percutaneous left atrial appendage occlusion in nonvalvular atrial
fibrillation patients with coronary heart disease

JIANG Xiaomin，LUO Jie，XIE Dujiang，ZHOU Ling，LIN Song，ZHANG Juan *
Department of Cardiology，the Affiliated Nanjing Hospital of Nanjing Medical University，Nanjing 210006，China

［Abstract］ Objective：This study aims to evaluate the safety and efficiency of the percutaneous left atrial appendage occlusion
（LAAO）in nonvalvular atrial fibrillation（NVAF）patients with coronary heart disease（CAD）. Methods：Total 51 NVAF patients were
consecutively accepted LAAO from June 2015 to July 2017. Patients were divided in two groups：15 with CAD and 36 without CAD.
All patients were followed up after discharge with transesophageal echocardiography（TEE）examination. Results：Patients with CAD
had higher incidence of hemorrhagic stroke or major bleeding than those without CAD. The incidence of end⁃point events had no
statistical difference between CAD group and non⁃CAD group. Compared with CAD patients who accepted long⁃term antithrombotic
medication，there was a further reduction of hemorrhage in CAD patients who accepted LAAO group. Moderate or severe left atrial
spontaneous echo contrast was correlated with the composite end point events. Conclusion：There are similar safety and effectiveness
for LAAO procedure in NVAF patients with or without CAD. Meanwhile，left atrial spontaneous echo contrast is a predictive factor of
LAAO in NVAF patients combined CAD.
［Key words］ nonvalvular atrial fibrillation；coronary heart disease；left atrial appendage occlusion；left atrial spontaneous echo con⁃
trast
［J Nanjing Med Univ，2021，41（09）：1354⁃1360，1387］

心房颤动（简称房颤）是最常见的一种心律失

［基金项目］ 南京市医学科技发展项目（YKK17101） 常，我国目前有超过800万非瓣膜性心房颤动（non⁃
［1］
valvular atrial fibrillation，NVAF）患者 ，占我国人口
∗
通信作者（Corresponding author），E⁃mail：yinyinye9157793@126.
com 的0.77%。房颤患者发生缺血性脑卒中的风险是非