摘要
目的分析器质性心脏病室性心动过速在穿刺、标测、消融过程中及围术期出现的并发症情况与处理策略,以提高对严重并发症的认识和处理能力。方法回顾性分析2009年8月至2015年8月江苏省人民医院行射频消融治疗的器质性心脏病室性心动过速患者42例,分析严重并发症的发生阶段、处理措施与预后。结果 42例器质性心脏病室性心动过速共消融50次,其中28次为心内膜消融,22次为心内膜与心外膜联合消融。术中及术后出现严重并发症3例(7.1%),其中1例为膈神经损伤,发生在心外膜特发瘢痕室性心动过速患者心外膜消融后,1个月后自行恢复;1例右心室破裂心脏压塞,发生在扩张型心肌病患者心外膜消融后,急诊开胸修补成功;1例肝血肿,发生在心脏结节病室性心动过速患者穿刺心包时,经肝血管造影加靶小动脉栓塞,肝血肿引流后好转。结论器质性心脏病室性心动过速心外膜射频消融过程中并发症不可避免,规范操作可减少并发症发生,及时正确处理可有利于并发症转归。
Objective To analyze the severe complications occured during puncture, mapping and ablation for ventricular tachycardia （VT） in patients with structural heart diseases, in order to improve the understanding of the severe complications and their management. Methods From August 2009 to August 2015, 42 patients with structural heart diseases and VT who accepted epicardial mapping and ablation of VT in Jiangsu province people＇s hospital were retrospectively analyzed. The possible causes of complications, treatment strategy and their evolution were studied. Results A total of 50 mapping and ablation procedures were performed in the 42 patients, edocardial mapping and ablation for 28 times and epicardal and edocardial mapping and ablation for 22 times. 3 （7. 14% ） patients suffered from severe complications during procedure. Phrenic nerve injury （PNI） after epicardial ablation happened in 1 patient with idiopathic epicardial scar VT and it recovered spontaneously after one month. Pericardia] tamponade due right ventricular rupture occurred during epicardial ablation in 1 patient with DCM who received fight ventricle repair by emergent surgery. Liver hematoma occurred in 1 cardiac sarcoidosis patient with VT during pericardium puncture and was treated by target small hepatic artery embolization and drainage. Conclusions Complications of epicardial mapping and ablation of VT for structural heart diseases could hardly be completely avoided, standardized procedure can reduce complications, and timely recognition and treatment of complications can help to avoid severe consequence.
出处
《中国介入心脏病学杂志》
2015年第12期693-696,共4页
Chinese Journal of Interventional Cardiology
关键词
室性心动过速
射频消融
心脏压塞
并发症
Ventricular tachycardia
Epicardial ablation
Cardiac tamponade
Complications
