标题：射频消融术中不同剂量肝素钠对凝血功能的干预作用

      作者：刘威 1，向真 1，刘振芳 2，陈艳琴 1，汤长春 3，张翼 1
    (1.湖南师范大学第一附属医院心内科(湖南省人民医院)，湖南 长沙 410005；
2.株洲市中心医院心内科，湖南 株洲 426100；
3.长沙市中心医院心内科，湖南 长沙 410006)

      卷次： 2016年27卷17期

      【摘要】 目的 探讨射频消融术(RFCA)对凝血功能的影响及不同剂量肝素钠的干预作用。方法 选择
2014年 12月至 2015年 11月在湖南省人民医院心内科首次行RFCA治疗的房室结折返性心动过速患者 30例，
根据术中经血管鞘注射不同剂量普通肝素钠分为A组(70 U/Kg) 15例和B组(100 U/Kg) 15例，分别于术前、射
频消融术后即刻、术后 24 h、术后 3 d、术后 5 d、术后 7 d共 6个时间段采静脉血标本，立刻做血浆D-二聚体检测。
结果 ①组内比较：A组患者射频消融术后即刻、术后 24 h和术后 3 d的D-二聚体值分别为(2.280±0.081) mg/L、
(0.821±0.119) mg/L、(0.485±0.119) mg/L，均明显高于术前的(0.366±0.070) mg/L，差异均有统计学意义(P<0.05)，术
后7 d D-二聚体值[(0.361±0.099) mg/L]恢复术前水平。B组患者射频消融术后即刻(2.191±0.074) mg/L、术后24 h
(0.749±0.006) mg/L、术后 3 d (0.410±0.006) mg/L的D-二聚体均较术前的(0.372±0.008) mg/L明显升高，差异均有
统计学意义(P<0.05)，术后 5 d D-二聚体值[(0.367±0.068) mg/L]恢复术前水平。②组间比较：射频消融术后即刻、
术后 24 h、术后 3 d、术后 5 d，A组D-二聚体升高的程度明显大于B组，差异均有统计学意义(P<0.05)。结论 射
频消融术会影响患者D-二聚体的变化，从而影响凝血功能，有形成血栓栓塞的风险；为减少射频消融术中血栓形
成的风险，推荐在术中运用100 U/Kg肝素钠。

      【关键词】 射频消融术；D-二聚体；肝素钠；凝血功能

      【中图分类号】 R654 【文献标识码】 A 【文章编号】 1003—6350（2016）17—2795—03


Intervention effect of different doses of heparin sodium in radiofrequency catheter ablation on coagulation
function.
LIU Wei 1, XIANG Zhen 1, LIU Zhen-fang 2, CHEN Yan-qin 1, TANG Chang-chun 3, ZHANG Yi 1. 1. Department
of Cardiology, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha
410005, Hunan, CHINA; 2. Department of Cardiology, Central Hospital of Zhuzhou, Zhuzhou 426100, Hunan, CHINA;
3. Department of Cardiology, Changsha Central Hospital, Changsha 410006, Hunan, CHINA

【Abstract】 Objective To explore the impact of radiofrequency catheter ablation (RFCA) on coagulation func-
tion and the preventive effect of different doses of heparin sodium in related patients. Methods Thirty patients with
atrioventricular nodal reentrant tachycardia who underwent RFCA for the first time in the First Affiliated Hospital of
Hunan Normal University from December 2014 to November 2015 were divided into two groups according to intraop-
erative vascular sheath injection of different doses of unfractionated heparin sodium: group A (70 U/kg, n=15), group
B (100 U/kg, n=15), respectively. Venous blood samples were collected before operation, immediately after radiofre-
quency ablation, 24 h, 3 d, 5 d, 7 d after operation for detection of plasma D-dimer. Results ① Within group com-
parison: In group A, D-dimer levels immediately after radiofrequency ablation, 24 h after operation, 3 d after opera-
tion were significantly higher than those before surgery [(2.280±0.081) mg/L, (0.821±0.119) mg/L, (0.485±0.119) mg/L
vs (0.366±0.070) mg/L, P<0.05], while the D-dimer level 7 d after operation showed no statistically significant differ-
ence with that before operation [(0.361±0.099) mg/L vs (0.366±0.070) mg/L, P>0.05]; In group B, D-dimmer levels im-
mediately after radiofrequency ablation, 24 h after operation, 3 d after operation were significantly higher than that be-
fore surgery [(2.191±0.074) mg/L, (0.749±0.006) mg/L, (0.410±0.006) mg/L vs (0.372±0.008) mg/L, P<0.05], while the
level 5 d after operation showed no statistically significant difference with that before operation [(0.367±0.068) mg/L vs
(0.372±0.008) mg/L, P>0.05]. ② Comparison between groups: D-dimmer levels immediately after radiofrequency abla-
tion, 24 h, 3 d, 5 d after operation in group A were significantly higher than those in group B (P<0.05). Conclusion Radio-
frequency catheter ablation may affect changes in D-dimer of the patients, thereby affecting coagulation, with a risk of
thrombosis embolism. To reduce the risk of thrombosis, heparin sodium at the dose of 100 U/kg is recommended during
surgery.

      【Key words】 Radiofrequency catheter ablation; D-dimmer; Heparin sodium; Coagulation
·论 著·
6350.2016.17.014