儿童室间隔缺损经导管封堵术后心律失常的随访研究  

Prevalence and risk factors of arrhythmias after transcatheter closure of ventricular septal defect in children

作　　者：钟庆华[1,2] 郑鸿雁[2] 张智伟[2] 钱明阳[2] 谢育梅[2] 王树水[2] 

机构地区：[1]深圳市龙岗中心医院心内科 [2]广东省人民医院广东省心血管研究所心血管儿科,广州510080

出　　处：《中华心血管病杂志》2014年第10期840-845,共6页Chinese Journal of Cardiology

基　　金：国家“十二五”科技支撑计划项目（2011BA111B22）

摘　　要：目的 探讨儿童室间隔缺损经导管封堵术后心律失常的发生率及其危险因素.方法 收集2002年1月至2010年12月在广东省人民医院行经导管封堵术的1 069例室间隔缺损患儿的临床资料进行回顾性分析.其中,男性583例;年龄（7.7±3.6）岁.室间隔缺损直径（4.0±1.8）mm,合并膜部瘤336例.术后第1、3天检查心电图;出现心律失常者住院期间每天记录心电图;出院后,在术后第1、3、6、12个月检查心电图,之后每年随访记录心电图.采用多因素logistic回归分析术后发生心律失常的危险因素.结果 所有患者均成功封堵室间隔缺损,封堵器直径（7.2±2.1）mm.随访时间为2.2（1.0～4.2）年.术后早期（＜1个月）出现心律失常263例（24.6％）,严重心律失常50例（4.7％）,无死亡病例.随访期间,出现迟发（≥1个月）传导阻滞43例（4.0％）,其中完全性房室传导阻滞4例（0.4％）.多因素logistic回归分析显示,使用小腰大边型封堵器（OR=2.426,95％ CI：1.835 ～3.208,P＜0.001）、男性（OR=1.267,95％ CI：1.055～1.523,P=0.011）、是术后早期出现心律失常的危险因素,高体质量是早期心律失常保护性因素（OR =0.838,95％ CI：0.737 ～0.951,P=0.006）;使用偏心型封堵器（OR=4.777,95％ CI：2.079～10.978,P＜0.001）、手术时间长（OR=1.011,95％ CI：1.002～1.020,P=0.012）,使用进口封堵器（OR=2.621,95％ CI：1.143～6.014,P=0.021）是术后早期出现严重房室传导阻滞的危险因素;使用小腰大边型封堵器（OR=2.654,95％ CI：1.042-6.760,P=0.041）是迟发传导阻滞的危险因素,高体质量是迟发传导阻滞保护性因素（OR=0.373,95％ CI：0.159-0.875,P=0.023）.结论 室间隔缺损患儿经导管封堵术后早期心律失常常见,而迟发严重房室传导阻滞少见.行经导管封堵术的室间隔缺损患儿体质量不宜过轻,尽可能选择对称型封堵器.Objective To evaluate the prevalence and risk factors of arrhythmia after transcatheter closure of ventricular septal defect （VSD） in children.Methods A total 1 069 children （583 males,mean age （7.7 ± 3.6） years） underwent transcatheter closure of VSD from January 2002 to December 2010 in our hospital were enrolled and retrospectively analyzed.VSD diameters were （4.0 ± 1.8） mm,336 cases accompanied membranous aneurysm.Electrocardiogram were performed at 1,3 days after the procedure.Once arrhythmias recorded,electrocardiogram was performed daily till discharge.All cases were followed up by ECG at 1,3,6,12 months after the procedure in outpatient department and then in a year interval.The risk factors were identified by multivariable logistical analysis.Results All VSDs were closed successfully and the diameters of occluder was （7.2 ± 2.1） mm.The median follow-up time was 2.2 （1.0-4.2）years.Mortality was zero during follow up.Incidence of early （〈 1 month） post-procedure arrhythmias was 24.6 % （263 cases）,and severe arrhythmias were recorded in 50 cases （4.7%）.There were 43 late （≥1month） post-procedure arrhythmias （4.0%） including 4 （0.4%） complete atrioventricular block.Multivariable logistic analysis revealed that VSD treated with thin-waist-big-side occluder （OR =2.426,95% CI：1.835-3.208,P 〈 0.001）,male gender（OR =1.267,95% CI：1.055-1.523,P =0.011） were the risk factors while higher body weight （OR =0.838,95% CI：0.737-0.951,P =0.006） was protective factor for early onset arrhythmia.Placement of asymmetrical occluder （OR =4.777,95% CI：2.079-10.978,P 〈 0.001）,longer procedure time （OR =1.011,95% CI：1.002-1.020,P =0.012）,occluder from foreign countries （OR =2.621,95% CI：1.143-6.014,P =0.021） were the risks factors for early onset severe conduct block.Treatment with thin-waist-big-side occluder （OR =2.654,95% CI：1.042-6.760,P =0.041） was the risk factor while higher body weight （OR =0.373,95% CI：0.159-0.875,P=0.

关 键 词：心律失常 室间隔缺损 心脏导管插入术 

分 类 号：R725.4[医药卫生—儿科]