左心耳閉合手術於預防心源性血栓的應用

10.6666/ClinMed.2017.80.5.115

劉馨惠；羅力瑋；陳適安

心房顫動(atrial fibrillation) ； 預防心源性血栓 ； 口服抗凝血藥物 ； 左心耳閉合手術

臨床醫學月刊

80卷5期（2017 / 11 / 24）

625 - 628

繁體中文

心房顫動(atrial fibrillation)是所有心律不整中最常見的型態，其中發病率隨著年紀大於六十五歲而顯著上升到百分之七。這些病患隨時暴露在高血栓風險之下，尤其腦部缺血型中風。根據統計，腦部缺血型中風有百分之二十與心房顫動有顯著相關性且近一半的病患會在一年內死亡。同時，心房顫動的病患比正常人多兩倍的死亡率、三倍的心臟疾病及多百分之十的住院率。過去五十年來，維生素K拮抗劑(vitamin K antagonist, VKA)是唯一預防心房顫動產生血栓的口服抗凝血藥物，但病患須定期追蹤凝血功能及防範藥物相互作用所帶來的併發症。近年來，非維生素K拮抗劑(non-vitamin K oral anticoagulant, NOAC )的研發與使用在臨床上顯示與傳統維生素K拮抗劑預防中風效果相近，甚至更有效且更安全。儘管心房顫動病患中預防血栓有新的藥物選擇，病患仍然暴露在出血傾向的高風險之中，故發展出能降低出血風險及相關併發症的治療成為新目標。研究證實，心房顫動產生的血栓多源自原始肺靜脈的囊狀結構，稱為左心耳(left atrial appendage, LAA)。臨床發現許多非瓣膜型心房顫動產生的血栓多源自這構造封閉又崎嶇的左心耳而非平滑的左心房。因此，左心耳閉合手術成為預防血栓及降低出血風險的新選擇。近年來，有許多臨床研究顯示左心耳閉合手術比傳統維生素K拮抗劑有更多療效與優點。未來，隨著左心耳閉合手術的興起與探討，希望能有效預防心房顫動所帶來的風險與併發症。

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