先天性完全性房室传导阻滞临床特征及心脏起搏器的安置选择  

Clinical features of congenital complete atrioventricular block and its indications for permanent cardiac pacing

作　　者：李奋[1] 周爱卿[1] 高伟[1] 李筠[1] 黄美蓉[1] 

机构地区：[1]上海第二医科大学附属上海儿童医学中心,200127

出　　处：《中国介入心脏病学杂志》2001年第1期13-15,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨先天性完全性房室传导阻滞（ＣＣＡＶＢ）临床特征及并发阿斯综合征安置心脏起搏器的指征。方法１９７４年３月至２０００年６月我院住院及门诊共６６例ＣＣＡＶＢ患儿，２例伴室间隔缺损，２５例伴轻重不一的阿斯综合征。本组病例均经临床检查、心电图、胸部Ｘ线检查、有关实验室检查而确诊。无阿斯综合征发作者一般门诊随访，对有阿斯综合征发作者先予以异丙基肾上腺素等处理，如药物治疗无效行临时右室心脏起搏。频繁发作者考虑安置埋藏式心脏起搏器。所有患儿均定期随访。除常规心电图检查外，部分病例加做Ｈｏｌｔｅｒ检查、运动试验等。安置埋藏式心脏起搏器的患儿还需评估起搏疗效及起搏器功能情况。结果本组２５例发生阿斯综合征，初次发作年龄（４．５±２．６）岁，发作时心率为３６－５３次／ｍｉｎ（平均４１±３．５）次／ｍｉｎ。发作时１０例为缓慢心率，心率＜４０次，１３例为室性心动过速，主要为扭转型室速（Ｔｄｐ），２例不详。阿斯综合征发作相关因素有年龄、心率、ＱＴ间期、运动耐受性及血钾水平。随访中无阿斯综合征发作者均能正常生活。阿斯综合征发作者经异而基肾上腺素、维持钾平衡及利多卡因等药物治疗大都可控制。少数经药物治疗无效者应用临时右室心脏起搏，都?Objective The data of 66 patients with congenital complete atrioventricular block (CCAVB) were analyzed retrospectively to investigate the clinical features of CCAVB and its indications for permanent cardiac pacing. Methods Between March 1974 to June 2000, 66 patients (inpatients and outpatients) were confirmed with CCAVB in our hospital, 2 of those with ventricular septal defects and 25 with onsets of Adams-Stokes syndrome. The patients without onsets of Adams-Stokes syndrome were followed up in outpatient department. The patients with onsets of Adams-Stokes syndrome were treated with medicines. If they were unresponsive, the patients underwent temporarily right ventricular pacing. The patients with frequent onsets of Adams-Stokes syndrome were candidates for permanent cardiac pacing. All patients were followed up regularly, including electrocardiography, execise-test, efficiency of cardiac pacing and function of pacemaker (those received pacemakers), etc. Results In this series, 25 patients experienced onsets of Adams-Stokes syndrome. The mean age at initial onsets was 4.5 ± 2.6years and the mean heart rate 41 ± 3.5 beats per minute. During the period of onsets, electrocardiograms showed bradycardia in 10 patients, ventricular tachycardia (mainly torsades de pointes) in 13 patients and unknown in 2 patients. The factors relative to onsets of Adams-Stokes syndrome were age, heart rate, QT interval, exercise and the level of blood potassium. At the follow-up, those without onsets of Adams-Stokes syndrome lived normal lives. Majority with onsets of Adams-Stokes syndrome were controlled by infusion of isoproterenol, maintenance of potassium balance, infusion of lidocaine, etc. Minorith unresponsive to medicines underwent temporarily right ventricular pacing with good results. 9 patients with frequent onsets of Adams-Stokes syndrome and 2 patients with infrequent onsets of Adams-Stokes syndrome received permanent cardiac pacemaker implantations with good results, execpt 2 death relatted to pacemakers. Conclusi

关 键 词：房室传导阻滞 先天性 心脏起搏 

分 类 号：R541.76[医药卫生—心血管疾病]