摘要目的：比较应用不同直径球囊进行冷冻球囊消融(CBCA)治疗心房颤动(房颤)的特点,进一步提高手术疗效及安全性,降低手术风险。方法回顾性分析2014年6月至2015年6月于沈阳军区总医院心血管病研究所心内科采用 CBCA 治疗的50例房颤患者应用不同直径球囊的特点。结果根据患者采用不同大小球囊将50例患者分为两组,其中大球囊组(应用28 mm 直径的球囊)患者26例,小球囊组(应用23 mm 直径的球囊)24例。两组基本临床资料相似。小球囊组平均手术时间、X 线曝光时间和曝光量均明显低于大球囊组[(94.1±23.2) min 对(113.2±35.7) min；(18.0±4.9) min 对(26.1±10.6) min；(435.9±260.3) mGy 对(775.2±374.5) mGy,P<0.05],差异有统计学意义。4支肺静脉冷冻的最低温度小球囊组明显低于大球囊组。小球囊组患者总的冷冻次数、以及在冷冻左上肺静脉(LSPV)、右上肺静脉(RSPV)及右下肺静脉(RIPV)时的冷冻次数均小于大球囊组(P<0.05)。4支肺静脉监测肺静脉隔离时间,小球囊组短于大球囊组(P<0.05),肺静脉电隔离(PVI)时,LSPV、左下肺静脉(LIPV)、RSPV 的温度小球囊组也低于大球囊组,差异有统计学意义,(P<0.05)。手术中迷走神经反射的发生率小球囊组明显高于大球囊组,差异有统计学意义(54.2％对26.9％,P<0.05)。在大球囊组发生1例膈神经损伤。两组均无肺静脉狭窄、胃扩张等并发症。术后3~6个月随访,两组患者房颤复发率相似。结论小球囊消融房颤的成功率、复发率及安全性与大球囊相近。根据肺静脉直径的大小选择不同球囊冷冻消融时,应掌握各自的特性,提高手术成功率,对可能出现的并发症应积极做好预防工作。

abstractsObjective The characteristics of different cryoballoon for atrial fibrillation should be ana-lyzed in order to improve operation efficacy and safety and decrease operative risk. Methods From June 2014 to June 2015,the characteristics of different cryoballoon were analyzed in 50 patients with atrial fibrillation un-derwent cryoballoon ablation in Shenyang Northern Hospital. Results The patients were divided into two groups according to applying different cryoballoon.Twenty-six patients were enrolled in big balloon group(apply-ing 28 mm cryoballoon)and 24 patients were in small balloon group(applying 23 mm cryoballoon).The basic clinical characteristics were similar in two groups.The mean operative time,X-ray exposure time and exposure val-ue in small balloon group were less than that in big balloon group obviously[(94. 1±23. 2) min vs.(113. 2±35. 7) min,(18. 0±4. 9) min vs.(26. 1±10. 6) min,(435. 9±260. 3) mGy vs.(775. 2±374. 5) mGy,P<0. 05].The temperature in four pulmonary veins of each patient in small group was lower than that in big group.The total times of cryo and the times of cryo in LSPV,RSPV and RIPV in small group were all less than that in big group&nbsp;(P<0. 05).When pulmonary vein potential was isolation,the temperature was much lower and the time was much shorter in small group(P<0. 05).The incidence rate of vagal reflex was higher in small group than that in big group(54. 2% vs. 26. 9%,P<0. 05).Phrenicus palsy occurred in one patient in big group.No pulmonary vein stenosis and dilatation of stomach occurred. The rate of recurrence during 3,6 months follow-up in two groups was similar.Conclusion The rate of success and recurrence and the safety in two groups was similar. When applying different cryoballoon according to diameter of pulmonary vein,we should master the properties of different balloon to improve the success rate and prevent complications.