預防心房顫動形成血管栓塞之治療新趨勢──左心耳封堵術

New Treatment for Vascular Thrombosis Prevention in Patients With Atrial Fibrillation: Left Atrial Appendage Occlusion

心房顫動（atrial fibrillation, AF）是常見的心律不整，容易在心臟內形成血塊而引發腦中風， 因此預防腦中風是AF治療的重點之一，過去多數AF病人須終身服用口服抗凝血劑，但口服抗凝血劑容易有出血的危險，必須定期監測病人凝血酶原時間（prothrombin time）之國際標準值（international normalized ratio, INR），且容易與多種藥物與食物產生交互作用，左心耳封堵術（left atrial appendage occlusion）則是因應使用抗凝血劑有禁忌或者有出血高風險的心房顫動病人所發展出的新治療。將左心耳封堵器置於左心耳，可避免血液滯留產生血塊，術前需安排經食道超音波及電腦斷層檢查，置放過程則類似心導管檢查，術後應於加護病房密切觀察生命徵象、穿刺部位出血、以及心包膜填塞之合併症。轉出加護病房後，則須給予出院後有關日常活動、服用抗凝血劑及規則追蹤之衛教。左心耳封堵術的成效，研究結果雖未必都能顯著減少腦中風的發生，但是其所產生的出血合併症則顯著較口服抗凝血劑為低，未來仍需更多研究進行長期的追蹤與深入的探討，希望此篇文章能提供臨床護理人員照護接受左心耳封堵術病人時之參考。

Atrial fibrillation (AF) is a common type of arrhythmia that increases significantly the risk of blood clots in the heart and of stroke. Therefore, stroke prevention is a key goal of AF treatment. In the past, patients were required to take anticoagulants for the remainder of their life, to regularly the monitor international normalized ratio (INR) of prothrombin time (PT), and to avoid possible negative interactions with various drugs and foods. Left atrial appendage occlusion (LAAO), a novel device and technique, was thus developed for AF patients with contraindications to anticoagulants and a high risk of bleeding. When using this technique, the occluder is placed on the left atrial appendage in order to effectively prevent blood stasis and thrombi accumulation. Transesophageal echocardiogram and computed tomography are conducted prior to the LAAO procedure, which is similar to the procedure used for cardiac catheterization. After the LAAO procedure, the patient remains in the intensive care unit (ICU), where vital signs, bleeding at the puncture site, and pericardial tamponade complications are monitored. Health education on daily activities, anticoagulant use, and regular follow-up should be given prior to hospital discharge. While LAAO may not reduce the incidence of stroke, the benefits of this procedure include a significant reduction in bleeding complications as compared to procedures that use oral anticoagulants. Further studies including long-term follow up and in-depth examinations of this procedure are necessary. The present article offers a reference for clinical staffs who are responsible for the care of patients treated using the LAAO procedure.