室间隔缺损患者介入治疗后的心律失常观察  

The occurrence and reaching for the rules of arrythmia of the ventricular septal defect patients treated by VSD device occlusion

作　　者：王黎[1,2] 韩卫星[1,2] 徐岩[1,2] 程自平[1,2] 许邦龙[1,2] 朱润硕[1,2] 陈斌[1,2] 林先和[1,2] 史学功[1,2] 

机构地区：[1]安徽医科大学第一附属医院心内科,合肥230022 [2]安徽医科大学第一附属医院心电心功能科,合肥230022

出　　处：《安徽医科大学学报》2008年第1期72-74,共3页Acta Universitatis Medicinalis Anhui

摘　　要：目的探讨室间隔缺损(VSD)患者经导管室间隔封堵术(TCVSD)治疗后心律失常的发生情况及规律。方法选取经超声心动图临床表现诊断为VSD的患者共92例,对其心电图检查进行回顾性分析。结果束支传导阻滞占术后新发心律失常的33.33%,室性及室上性心律失常占29.17%,左心室高电压占27.08%,房室传导阻滞(AVB)占10.42%。3例术后3~7d发生Ⅰ度AVB,予以地塞米松(DXM)减轻水肿治疗后,其中2例术后11d^3周恢复正常,1例术后1月仍为Ⅰ度AVB。1例术后7d发生Ⅰ度AVB、一过性Ⅱ度AVB伴晕厥,经DXM治疗后,出院前心电图示Ⅰ度AVB,术后1月心电图随访正常。1例术后6d晕厥,心电图及心电监护示:Ⅰ度AVB、一过性Ⅲ度AVB、右束支传导阻滞(RBBB),立即予以激素和安装心脏临时起搏器治疗,术后10d恢复。结论TCVSD后1周内的心律失常主要表现为传导阻滞(包括束支传导阻滞和房室传导阻滞)、室性及室上性心律失常、左心室高电压。传导阻滞为术后最常见的心律失常类型,其中束支传导阻滞多发生于术后3~7d,以RBBB为主;房室传导阻滞多发生于术后5~7d,以Ⅰ度AVB多见。传导阻滞的发生可能与VSD部位、解剖结构、封堵器的张力及大小有关,此类患者术后应及早使用激素治疗,加强跟踪随访。室性及室上性心律失常、左心室高电压一般可自行恢复,无须干预。对于那些符合介入治疗适应证标准,但分流量仍较大、存在多处缺损的患者,术后1~3d不宜大量补液,以免加重心脏负担。Objective This paper aims at discussing the occurrence and the rules of arrhythmia of patients suffering the verntricular septal defect （VSD） after treated by transcatheter closure of congenital verntricular septal defect （TCVSD）. Methods 92 patients were diagnosed as VSD by transthoracic echodcardiography（TTE） and clinical symptom. All of them had been checked by electrocardiogram after operation. We analysed these results retrospectively. Results Among the arrhythmia occurring after operation, bundle branch block accounts for 33.33%, ventricular and supraventricular arrhythmia 29.17%, hypervohage of left ventricle 27.08%, and atrioventricular block （AVB） 10. 42%. 3 to 7 days later, 3 cases suffered Ⅰ degree AVB,two of which recovered 11 days to 3 weeks after being treated by dexamethasone（DXM） to relieve edema, and the other one still had Ⅰ degree AVB one month later. 1 case had Ⅰ degree AVB, temporary Ⅱ degree AVB together with syncope 7 days after operation, and after DXM treatment, electrocardiogram shows Ⅰ degree AVB before leaving hospital and it was also normal one month later after operation. In addition, 1 case suffered syncope, showing Ⅰ degree AVB, temporary Ⅲ degree AVB and fight bundle branch block （RBBB） by electrocardiogram. After treatment with hormone and cardiac temporary pacemaker, the patient recovered 10 days later after operation. Conclusion Within the first week after TCVSD, arrhythmia show themselves by block （including bundle branch block and atrioventricular block）, ventricular and supraventricular arrhythmia, and hypervohage of left ventricle. Bundle branch block, especially RBBB, is the most common type occurring in 3 to 7 days after operation. Atrioventricular block is most likely occur in 5 to 7 days after operation, Ⅰ degree AVB being the common type. It is very likely that block is relevant to VSD position, anatomical structure, and size and tension of occluder. For the patients with block, it is advisable to treat with hormone as soon a

关 键 词：室间隔缺损/外科学 导管插入术 心律失常/病因学 

分 类 号：R541.1[医药卫生—心血管疾病] R654.1[医药卫生—内科学]