经导管封堵小儿室间隔缺损围术期心律失常的处理  

Management of the arrhythmia around the procedure of transcatheter closure of ventricular septal defects in pediatric patients

作　　者：谢育梅[1] 张智伟[1] 李渝芬[1] 钱明阳[1] 王慧深[1] 

机构地区：[1]广东省心血管病研究所心儿科,广州510100

出　　处：《中华心血管病杂志》2005年第12期1092-1094,共3页Chinese Journal of Cardiology

基　　金：国家"十五"科技攻关项目:先天性心脏病介入治疗器械的研制(基金编号:2001BA706B09;滚动基金编号:2004BA706B11)

摘　　要：目的探讨经导管室间隔缺损封堵术围术期出现的心律失常的处理方法。方法对182例先天性室间隔缺损的患儿进行室间隔缺损封堵术,经心电监测、常规心电图检查和24h动态心电图检查,对围术期出现心律失常的31例患儿根据病情进行不同的处理。结果本组患儿无死亡,3例术后出现三度房室传导阻滞的患儿安装了临时起搏器,2例恢复窦性心律,1例转外科手术,外科术后恢复窦性心律。1例术中出现三度房室传导阻滞的患儿转心外科手术。左束支传导阻滞及二度房室传导阻滞的病例均行内科治疗并恢复,其他非严重心律失常病例给予内科对症治疗。结论经导管封堵室间隔缺损围术期心律失常的发生率相对较高,围术期的心电监测十分重要,术后要进行密切的随访观察。Objective To discuss the treatment of arrhythmia occurs in the process of transcatheter closure of perimembranous ventrieular septal defects （VSD） in pediatric patients. Methods 182 eases （mean age： 6. 2 ± 3.3 years） with membranous VSD underwent transeatheter occlusion procedure. Two different devices were used： the Amplatzer membranous VSD oeeluder in 81 patients and the domestic-made device in 101 patients. Electrocardiogram of all patients was recorded before and during closure and at one day after the procedure, and Holter monitoring was performed one week after the procedure. Results Perioperation arrhythmia occurred in thirty-one patients （17%）. Second- or third-degree atrioventrieular bundle （AVB） was noted during the procedure in four patients. Normal AV conduction recovered spontaneously before the catheters were withdrawn in three cases and another patient underwent surgical repair. In the other twenty-seven patients, arrhythmia was first documented between one day and one week after the procedure. Third-degree AVB was found in three （1.6%） children after the procedure and underwent the temporary pacemaker （TPM） was implanted, two of them recovered to normal sinus rhythm within one week, another patient underwent elective surgery to remove the occluder and repair the defect. Other arrhythmias were ： left bundle-branch block （ n = 3 ）, right bundle-branch block （ n = 12 ）, seconddegree AVB （ n = 2） , sinus taehyeardia （ n = 6 ） . Conclusions In properly selected cases of perimembranous VSD, the transcatheter closure is safe and effective by using appropriate devices. During and after the procedure, closure of VSD can be associated with some kinds of arrhythmia, such as A-V block, more intensive observation and follow-up were therefore needed.

关 键 词：室间隔缺损 导管插入术 心律失常 室间隔缺损封堵术 经导管封堵 围术期 三度房室传导阻滞 动态心电图检查 先天性室间隔缺损 二度房室传导阻滞 

分 类 号：R726.5[医药卫生—儿科]