摘要
目的 探讨心房颤动患者射频导管消融（下称消融）后发生急性肺水肿的机制。方法498例心房颤动患者在三维电解剖标测系统指导下消融，分析术后发生急性肺水肿的原因和机制。结果术后发生急性肺水肿5例（1％），其中阵发性心房颤动行环肺静脉电隔离术1例，持续性心房颤动环肺静脉电隔离附加碎裂电位和（或）顶部及二尖瓣峡部线性消融4例。术中平均生理盐水输入量（16304-367）ml。术后气促症状（〉20次／min）首发且进行性加重平均时间（25±3．9）h，平均心室率（95．24-5．9）次／min。低热2例，白细胞数升高3例[（10．7±1．0）×10^9／L]。所有患者高敏C反应蛋白[（40．9±6．0）mg／L]与N末端-脑钠肽前体[（1108±233）Pg／ml]明显升高．最低血氧饱和度（80．4±7．6）％，左心室射血分数及左心室舒张功能正常，肺静脉或动脉CT成像均表现为双下肺渗出性炎症，其中3例合并少量胸腔积液。糖皮质激素联合呋塞米治疗3-5d后痊愈。结论心房颤动消融后肺水肿多发生于左心房消融范围广泛者，其机制可能为系统性炎症反应综合征所致，经糖皮质激素联合利尿剂治疗效果良好。
Objective To investigate the mechanism of acute pulmonary edema （APE） after radiofrequency catheter ablation （RFCA） of atrial fibrillation （AF）. Methods 498 patients with AF underwent RFCA under guidance of 3- dimensional electro-anatomic mapping system and were evaluated. Results APE was diagnosed in 5 patients. Of them, one patient with paroxysmal AF underwent circumferential pulmonary vein isolatoin （CPVI）, the other 4 patients with persistent AF underwent fragmented potential ablation and / or left atrial roof and mitral isthmus linear ablation after CPVl. The mean volume of saline infused per subject was （1630±367）ml. The dyspnea （respiratory rate〉20 / min） as the first symptom developed at a mean time of （25 ± 3.9）h post procedure and the heart rate was （95.2±5.9）bpm. Low-grade fever was seen in 2 patients. White blood cell count increased in 3 patients [（10.7±1.0）×109 / L]. High-sensitive CRP [（40.9 ±6.0）mg / L）] and pro-BNP[（1 108± 233）pg / ml] increased in all patients. The blood oxygen saturation was （80.4 ± 7.6）%. The left ventricular ejection fraction and diastolic function were normal. The chest computed tomogram revealed bilateral infiltrates in the lower pulmonary fields in all 5 patients and a small pleural effusion in 3 of them. After treated with gluco- corticoids and furosemide, all patients recovered completely within 3 to 5 days. Conclusion APE after AF ablation occurs mostly in patients with extensive ablation of left atrium. Systemic inflammatory response may be a possible mechanism and glucocorticoids combined with diuretics are an effective treatment of APE.
出处
《心电与循环》
2012年第1期6-9,共4页
Journal of Electrocardiology and Circulation
关键词
心房颤动
射频导管消融
急性肺水肿
系统性炎症反应综合征
Atrial fibrillation
Radiofrequency catheter ablation
Acute pulmonary edema
Systemic in-flammatory response
