本文選題：非瓣膜性心房顫動(dòng) + 導(dǎo)管射頻消融術(shù)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)新型口服抗凝劑(利伐沙班和達(dá)比加群酯)與華法林用于非瓣膜性心房顫動(dòng)患者導(dǎo)管射頻消融術(shù)后抗凝治療的效果。方法:本研究為回顧性觀察研究。選擇研究對(duì)象為2014年6月至2015年5月在本中心非瓣膜性持續(xù)性或者陣發(fā)性心房顫動(dòng)患者246例,觀察導(dǎo)管射頻消融術(shù)后抗凝治療,其中利伐沙班組和華法林組兩兩配對(duì)各62例,術(shù)后利伐沙班組每天給予15mg,qd,po。華法林組每天給予3-5mg,根據(jù)國(guó)際標(biāo)準(zhǔn)化比值(international normalized ratio,INR)控制INR在2.0-3.0之間。同期達(dá)比加群酯和華法林配對(duì)各61例,達(dá)比加群組每天給予110mg,bid,po。華法林組同上。所有患者術(shù)后3個(gè)月抗凝期均選用同一種藥物。統(tǒng)計(jì)手術(shù)后3個(gè)月,抗凝療效終點(diǎn)是腦卒中或全身栓塞事件;安全終點(diǎn)是重大出血,房顫復(fù)發(fā)率、并發(fā)癥等不良事件發(fā)生情況。結(jié)果:1.基線水平的比較:利伐沙班與華法林組患者的基線特征和達(dá)比加群酯與華法林組患者的基線特征:包括年齡、BMI、房顫類型(陣發(fā)性和持續(xù)性)、CHA2DS2-VASc評(píng)分、HAS-BLED評(píng)分、術(shù)前化驗(yàn)指標(biāo)(HB、ALT、CCR、PT、APTT、TT),既往合并癥(充血性心力衰竭、高血壓、糖尿病、甲狀腺功能異常、COPD、腦卒中/全身性栓塞/TIA)、術(shù)前LAD、EF%術(shù)前用藥(可達(dá)龍、阿司匹林、華法林、ACEI、β-受體阻滯劑)術(shù)前使用華法林患者兩組比較有顯著性差異,其他比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.抗凝療效和安全終點(diǎn)比較:均為消融術(shù)后3個(gè)月隨訪。(1)利伐沙班和華法林組均無(wú)死亡病例,利伐沙班組無(wú)栓塞事件(腦卒中/TIA/全身性栓塞),對(duì)照華法林組TIA1例,無(wú)腦卒中,全身栓塞事件。兩組在卒中風(fēng)險(xiǎn)比較上差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者均未出現(xiàn)嚴(yán)重出血事件,利伐沙班組牙齦出血3例,無(wú)痰中帶血,血尿6例,皮下出血2例,腹股溝血腫3例。對(duì)照華法林組牙齦出血1例,痰中帶血3例,血尿6例,腹股溝血腫3例,患者停藥后出血癥狀消失。兩組不明顯出血事件比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)達(dá)比加群酯組和華法林組均無(wú)死亡病例,達(dá)比加群酯組TIA2例,無(wú)腦卒中和全身栓塞事件,對(duì)照華法林組無(wú)栓塞事件(TIA/腦卒中/全身性栓塞).兩組在卒中風(fēng)險(xiǎn)比較上差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者均未出現(xiàn)嚴(yán)重出血事件,達(dá)比加群酯組牙齦出血1例,無(wú)痰中帶血,血尿8例,皮下出血3例,腹股溝血腫4例。對(duì)照華法林組牙齦出血4例,痰中帶血3例,血尿4例,腹股溝血腫2例,患者停藥后出血癥狀消失。兩組不明顯出血事件比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.房顫復(fù)發(fā),并發(fā)癥比較(1)利伐沙班和華法林組利伐沙班組檢查房顫復(fù)發(fā)10例,電復(fù)律5例,發(fā)熱10例。華法林組房顫復(fù)發(fā)13例,電復(fù)律5例,發(fā)熱4例。其并發(fā)癥經(jīng)對(duì)癥治療均在出院時(shí)痊愈。兩組復(fù)發(fā)和并發(fā)癥比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組依從性比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)達(dá)比加群酯和華法林組達(dá)比加群酯組和華法林組電復(fù)律各6例。達(dá)比加群酯房顫復(fù)發(fā)20例,發(fā)熱9例。華法林組房顫復(fù)發(fā)16例,發(fā)熱4例。其并發(fā)癥經(jīng)對(duì)癥治療均在出院時(shí)痊愈。兩組復(fù)發(fā)和并發(fā)癥比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組依從性比較差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:口服利伐沙班和達(dá)比加群酯用于非瓣膜性房顫經(jīng)導(dǎo)管射頻消融術(shù)抗凝治療,在卒中和出血風(fēng)險(xiǎn)上均安全有效,不劣于華法林且無(wú)需檢測(cè)凝血指標(biāo)。
[Abstract]:Objective: To evaluate the effect of new oral anticoagulants (Lev Shaaban and dabatagate) and Hua Falin for anticoagulant therapy after catheter radiofrequency ablation for non valvular atrial fibrillation. Methods: This study was a retrospective study. The selected subjects were the non valvular or paroxysmal heart in this center from June 2014 to May 2015. 246 patients with atrial fibrillation were treated with anticoagulant therapy after radiofrequency catheter ablation. Among them, 62 cases were matched in the rivara group and the warfarin group in 22. 15mg, QD, po. warfarin group were given 3-5mg every day after the operation, and INR was controlled by the international standardized ratio (international normalized ratio, INR) between 2.0-3.0. 61 cases were added with group of ester and Hua Falin. Dabiga group was given 110mg, bid, and po. Hua Falin. All patients selected the same drug at 3 months after operation. 3 months after operation, the end point of anticoagulant effect was stroke or systemic embolism; the end of safety was major bleeding, recurrence rate of atrial fibrillation, complications and other adverse events. Results: 1. baseline levels: baseline characteristics of patients with LEV Shaaban and warfarin group and baseline characteristics of dabiga group and warfarin group: age, BMI, atrial fibrillation type (paroxysmal and persistent), CHA2DS2-VASc score, HAS-BLED score, preoperative test indicators (HB, ALT, CCR, PT, APTT, TT), previous complication (hyperemia) Heart failure, hypertension, diabetes, thyroid dysfunction, COPD, cerebral apoplexy / systemic embolism /TIA), pre operation LAD, EF% before operation (Aron, aspirin, Hua Falin, ACEI, beta blocker) before the operation of the two groups of Hua Falin patients were significantly different, the other comparison was not statistically significant (P0.05).2. anticoagulant efficacy and safety All end point comparison: 3 months after ablation. (1) there was no death case in rivah Shaaban and Hua Falin group. There was no embolism event in rivah group (/TIA/ systemic embolism of stroke), compared with group TIA1 in Hua Falin group, no stroke and whole body embolism. There was no statistical difference between the two groups in stroke risk comparison (P0.05). Two groups were all patients. There were no serious bleeding events, 3 cases of gingival bleeding in the rivana group, 6 cases of bleeding in the sputum, 6 cases of hematuria, 2 cases of subcutaneous hemorrhage, 3 cases of inguinal hematoma, 1 cases of gingival bleeding in the control warfarin group, 3 cases of blood in the phlegm, 6 cases of hematuria, 3 cases of inguinal hematoma, and the loss of bleeding symptoms after stopping the drug. The difference of no significant bleeding events in the two groups was not statistically significant. (P0.05). (2) there were no deaths in the dabiga group and the Hua Falin group, and the dabiga group was TIA2, without stroke and systemic embolism, compared with the Hua Falin group without embolization (TIA/ stroke / systemic embolism). The difference between the two groups was not significant (P0.05) in the stroke risk comparison (P0.05). There was no serious bleeding event in the two groups. There were 1 cases of gingival bleeding in dababatm group, 8 cases in no sputum with blood, hematuria, 3 cases of subcutaneous hemorrhage, 4 cases of inguinal hematoma, 4 cases of gingival bleeding in the control warfarin group, 3 cases of blood in the phlegm, 4 cases of hematuria, 2 cases of inguinal hematoma, and the bleeding symptoms disappeared in the patients after stopping medicine. There was no statistically significant difference between the two groups (P0.05) the recurrence of.3. atrial fibrillation in the two groups. Complications were compared (1) there were 10 cases of recurrence of atrial fibrillation in Rivelling Shaaban and warfarin group, 5 cases of electric cardioversion, 10 cases of fever, 13 cases of atrial fibrillation in warfarin group, 5 cases of electric cardioversion, 4 cases of fever. The complications were all healed at discharge. The recurrence and complications of the two groups were not statistically significant (P0.05). The compliance ratio of the two groups was not significant. The difference was not statistically significant (P0.05). (2) dabiga group ester and Hua Falin group Dabi group ester group and Hua Falin group electric cardioversion each 6 cases. Dabiga group ester atrial fibrillation recurrence 20 cases, fever 9 cases. Hua Falin group atrial fibrillation recurrence 16 cases, 4 cases of fever. The complications are all cured at the time of hospital treatment. The two groups of recurrence and complications are all the difference is no Statistical significance (P0.05). There was no significant difference in the compliance of the two groups (P0.05). Conclusion: oral Lev Shaaban and dabiaga were used for anticoagulant therapy of non valvular atrial fibrillation via catheter radiofrequency ablation, which were safe and effective in the risk of stroke and bleeding, not inferior to warfarin and no need to detect coagulation indexes.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75

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