导管射频消融术对凝血功能影响研究.docVIP

导管射频消融术对凝血功能影响研究 　　 【摘要】 目的：探讨射频导管消融术(RFCA)对凝血功能的影响及其对血栓性疾病的预测意义。方法：选取68例接受RFCA术的患者，在RFCA术前、心内电生理检查之后、成功消融放电即刻、术后24 h，术后第3 天和第7 天，抽取静脉血标本，采用ELISA法测定血浆中的凝血物质D-二聚体(D-dimer)、血小板 -颗粒膜糖蛋白(platelet -granule membrane glucoprotein， GMP-140)、凝血酶-抗凝血酶Ⅲ复合物(TAT)水平。结果：与穿刺血管之前相比较，血浆中D-二聚体在消融放电即刻达到高峰，于第7 天降至穿刺血管之前的水平。GMP-140的浓度在术后第3 天增至峰值，为穿刺血管前浓度的1.8倍。TAT呈现两次高峰：术后即刻第1次高峰(42.9±15.8 ng/ml)，术后3 d第2次高峰(20.3±19.2 ng/ml)。第2次高峰与EPS组之间比较差异有统计学意义(P 　　 【关键词】 导管消融； 血栓形成； D-二聚体； 血小板 -颗粒膜糖蛋白； 凝血酶-抗凝血酶Ⅲ复合??? 　　 　　 Effects of Radiofrequency Catheter Ablation in Coagulation System/NING Jing， WANG Hai-ming， SUN Xiao-fei， et al.//Medical Innovation of China，2012，9(12)：013-014 　　 【Abstract】 Objective： To observe the changes of the blood coaguable states due to radiofrequency catheter ablation(RFCA) and the predictive significance of thrombotic disease. Methods： Selected 68 patients who underwent RFCA in treatment subject. The plasma levels of D-dimer， platelet-granule membrane glucoprotein(GMP-140). The thromb in-antithromb inⅢ complex(TAT) were assayed by enzyme-linked immuno sorbent assay(ELISA). Blood samples were obtained by inserting veins before RFCA was performed， just at the time that RFCA was accomplished， the third day and the seventh day after RFCA. Results： The plasma levels of D-dimer increased distinctly just the time RFCA was performed， and restored in the seventh day after RFCA， contrasted to the levels of those before RFCA was performed. While the peak level of GMP-140 was presented at the third day after RFCA， which was 1.8 times the initial one. Plasma TAT exhibited a double peaked pattern： the first peak occurred instantly after RFCA(42.9±15.8 ng/ml)， and the second peak at 3 days later(20.3±19.2 ng/ml). The second peak was significantly higher than that of the control group(P 　　1.2 射频消融方法 (1)AVNRT慢径的消融：患者平卧于手术台上，连接心电监护，接背电极。常规消毒铺巾，1%利多卡因局麻后分别行右股静脉及右颈内静脉穿刺，分别置入6F、8F、6F鞘管，取右前斜位，送入加硬大头导管至右心房，在CS与His连线中下1/3处标记到小A大V波，在此以20~25 W，55 ℃放电，5~10 s内出现结性心律与窦性心律交替，此时为有效放电，