Предикторы развития осложнений у пациентов с предсердными аритмиями при катетерной абляции сердца

Актуальность изучения предикторов развития осложнений катетерной абляции (КА) у пациентов с предсердными аритмиями обусловлена неоднородностью их популяции и отсутствием единых алгоритмов перипроцедурного ведения.

Цель исследования: определить факторы риска развития процедурных осложнений (ПО) и осложнений седации и аналгезии у пациентов с КА при предсердных аритмиях.

Материалы и методы. Провели одноцентровое ретроспективное когортное обсервационное исследование с анализом 2340 электронных медицинских карт (ЭМК) из базы Северо-Западного государственного медицинского университета им. И.И. Мечникова в период с 2015 по 2022гг. В исследование включили данные ЭМК 1793 пациентов, которым выполнили радиочастотную КА при предсердных аритмиях под «процедурной» седацией и аналгезией (ПСА). Выделение факторов риска развития ПО и осложнений ПСА провели с использованием однофакторного регрессионного анализа и многофакторной логистической регрессии с использованием пакета программ Jamovi 2.3.21 и IBM SPSS Statistics 26.

Результаты. Частота ПО составила 3,29%, а осложнений ПСА - 0,73%. Среди ПО преобладали гемоперикард/тампонада – 1,45%, и ОНМК/ТИА – 1,17%. Осложнения ПСА были представлены синдромом послеоперационной тошноты и рвоты - 0,22% и депрессией дыхания (ИВЛ - 0,06% и НИВЛ - 0,45%). 30,5% ПО регистрировали у пациентов в возрастной группе 70-74 года. Установили, что ИМТ > 30,0 кг/м² (скорректированный ОШ: 1,963; 95% ДИ: 1,09; 3,36, p=0,023), возраст ˃ 69 лет (3,081; 1,764-5,383, р <0,001), выраженность боли по цифровой рейтинговой шкале (ЦРШ) >3 баллов (4,317; 2,390 - 7,800, р <0,001), наличие КА в анамнезе (10,276; 4,006-26,354, <0,001) являются факторами риска развития ПО, тогда как ИМТ> 35 кг/м² (4,955; 1,485 - 16,535, р = 0,009) и длительность КА > 142 мин. (11,070; 2,440-50,228, р=0,002) - предикторами осложнений ПСА.

Заключение. Независимыми предикторами развития осложнений КА являлись: факторы, связанные с пациентом - ИМТ> 30,0 кг/м², возраст ˃ 69 лет, и с процедурой КА - продолжительность КА> 142 мин, КА в анамнезе, а также наличие боли с интенсивностью >3 баллов по ЦРШ.

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