2020 年第 1 期 第 15 卷

心房颤动射频消融术中心脏压塞的外科处理

Surgical management for cardiac tamponade following atrial fibrillation radiofrequency ablation

作者：于建波来永强

英文作者：

单位：北京市心肺血管疾病研究所首都医科大学附属北京安贞医院心脏外科100029

英文单位：

关键词：心房颤动；射频消融；心脏压塞；外科治疗

英文关键词：

• 摘要：

• 【摘要】目的    探讨心房颤动射频消融术中发生心脏压塞后行外科开胸手术的必要性和临床经验。方法    回顾性收集2008年1月至2018年6月首都医科大学附属北京安贞医院行心房颤动导管射频消融术中、术后发生心脏压塞并需外科急诊开胸止血的31例患者的临床资料，分析心脏压塞的表现及手术处理方案。结果    31例患者心脏损伤的部位为下腔静脉1例（3.2%）、右心房3例（9.6%）、右心室13例（41.9%）、左心房14例（45.2%）。所有患者均在X线透视下行心包穿刺引流，正中开胸，清除心包内积血块，缝合穿孔部位止血。2例患者于术后1～3 d因多脏器衰竭死亡；29例患者术后住重症监护病房时间1～16 d，平均（3.0±1.8）d；术后住院时间10～24 d，平均（12±7）d。术后出现下肢静脉血栓1例，肺部感染3例，肾功能衰竭1例，均经治疗后好转。结论    心脏压塞是心房颤动射频消融术的危急并发症，可造成死亡。临床处理上应首先进行心包穿刺引流和置管引流减压，对于引流后血流动力学仍不稳定的患者应及时行外科开胸修补手术。

• 【Abstract】Objective    To investigate the clinical experience of surgical thoracotomy for cardiac tamponade following radiofrequency ablation for atrial fibrillation. Methods    From January 2008 to June 2018, 31 patients had cardiac tamponade during or after atrial fibrillation radiofrequency catheter ablation and required surgical treatment in Beijing Anzhen Hospital, Capital Medical University. Clinical record of the patients were retrospectively analyzed. Manifestations of cardiac tamponade and surgical methods were analyzed. Results    Locations of cardiac injury in 31 patients were inferior vena cava(1 case, 3.2%), right atrium(3 cases, 9.6%), right ventricle(13 cases, 41.9%) and left atrium(14 cases, 45.2%). With the guidance of X-ray fluoroscopy, pericardial puncture and drainage were performed through thoracotomy to clear pericardial blood clot, suture perforated site and stop bleeding. Two patients died of multiple organ failure in 1-3 days after surgery. In 29 survival patients, postoperative intensive care unit stay time was 1-16 days［mean （3.0±1.8）d］; postoperative hospital stay time was 10-24 d［mean （12±7）d］. Postoperative complications included 1 case of lower extremity venous thrombosis, 3 cases of pulmonary infection and 1 case of renal failure; all patients recovered well after treatments. Conclusions    Cardiac tamponade is a fatal complication following atrial fibrillation radiofrequency ablation. Pericardial puncture and drainage should be performed urgently. Pericardial repair through surgical thoracotomy should be performed in patients with persistent unstable hemodynamics.