国产封堵器治疗膜部室间隔缺损并发心律失常的分析及两种防治措施对心律失常转归的影响  

The analysis of arrhythmia complicated during catheter closure of perimembranous ventricular septal defect with the home-made occluder and the effect of two prevention measures on the arrhythmia outcome

作　　者：陈章强[1] 姚薏[2] 洪浪[1] 王洪[1] 陆林祥[1] 尹秋林[1] 

机构地区：[1]江西省人民医院心内科,南昌330006 [2]华东交通大学医院

出　　处：《临床心血管病杂志》2015年第3期279-282,共4页Journal of Clinical Cardiology

摘　　要：目的：探讨国产封堵器治疗膜部室间隔缺损（VSD）并发心律失常的原因及2种防治措施对心律失常转归的影响。方法：入选先天性心脏病膜部VSD并行介入治疗的患者260例,年龄（16.3±12.5）岁,经胸超声检查VSD大小为（6.0±3.2）mm,随机分成两组：A组（130例）介入术后常规静脉滴注地塞米松3~10mg,或后续口服强的松3~7d;B组（130例）介入术后根据是否并发心律失常情况再静脉滴注地塞米松3~10mg或后续口服强的松3~7d。统计分析所有患者术中及术后并发的各种心律失常,并对其处理,随访3~6个月,观察其转归。结果：260例膜部VSD患者介入术中或术后共并发心律失常55例,平均年龄（13.8±11.6）岁;出现时间（3.6±1.4）d。其中A组10例（发生率7.7%）：完全性左束支阻滞1例,完全性右束支阻滞3例,不完全性右束支阻滞2例,加速性交界性心动过速伴干扰性房室脱节2例,左前分支阻滞2例;B组45例（发生率34.6%）：一过性Ⅲ度房室传导阻滞1例,高度房室传导阻滞1例,完全性左束支阻滞4例,间歇性左右束支传导阻滞3例,完全性右束支阻滞10例,不完全性右束支阻滞11例,左前分支阻滞6例,加速性交界性心动过速伴干扰性房室脱节9例;两组术后心律失常发生率比较,差异有统计学意义（P〈0.01）;经激素治疗后,B组中1例一过性Ⅲ度房室传导阻滞转为Ⅱ度Ⅰ型房室传导阻滞,随访3~6个月。B组中2例完全性右束支阻滞、2例不完全性右束支阻滞和3例左前分支传导阻滞未恢复,治愈率84.4%;而A组中只有1例完全性右束支阻滞治疗后未完全恢复,转为不完全性右束支阻滞,治愈率90%,两组术后心律失常治愈率比较差异有统计学意义（P〈0.05）。结论：应用国产封堵器介入治疗VSD比较安全有效,严重并发症极少,主要并发症为各种心律失常,如果及时发现,并给予激素治疗,约90%可以恢复,术后常规给予激素治疗,�Objective：To investigate the causes of arrhythmia complicated during and after catheter closure of perimembranous ventricular septal defect（pmVSD）with the home-made occluder and the effect of two prevention measures on the arrhythmia outcome.Method：Two hundred and sixty patients with pmVSD of congenital heart disease were enrolled in our hospital for catheter closure from January 2003 to September 2013 at age（16.3 ±13.2）years old,and diagnosed by transthoracic echocardiography,pmVSD size（6.0± 3.2）mm.All patients were randomly divided into two groups：group A（n=130）and group B（n=130）.Patients in group A after intervention were conventionally given ＂dexamethasone 3-10mg＂ by intravenous drip,or subsequent oral ＂prednisone＂ treatment 3-7days.Patients in group B after intervention were given ＂dexamethasone 3-10mg＂ by intravenous infusion,or subsequent oral ＂prednisone＂ treatment for 3-7days depending on whether arrhythmia occurs.All arrhythmia during occlusion were statistically analyzed and treated,and their outcome were observed after 3-6months follow-up.Results：Fifty-five cases of various arrhythmias occurred in two hundred and sixty patients during or after VSD intervention,aged（13.8±11.6）years old.Arrhythmias occurrence time was（3.6±1.4）d.Arrhythmias occurred in group A included one case of complete left bundle branch block,three cases of complete right bundle branch block,two cases of incomplete right bundle branch block,two cases of accelerated atrioventricular junctional tachycardia with atrioventricular interference and two cases of left branch block.There were total of ten cases of various arrhythmia and the incidence rate of arrhythmia was 7.7%.Arrhythmias occurred in group B included one case of transient Ⅲ degree atrioventricular block,one case of high degree atrioventricular block,four cases of complete left bundle branch block,three cases of intermittent left bundle branch or right bundle branch block,ten cases of complete right bundle branch bloc

关 键 词：膜部室间隔缺损 介入封堵 心律失常 不同治疗方式 

分 类 号：R541.1[医药卫生—心血管疾病]