小儿经导管封堵膜周部室间隔缺损术后发生左束支传导阻滞的临床研究  

Left bundle branch block after transcatheter closure of perimembranous ventricular septal defect in pediatric patients

作　　者：陈大业[1,2] 钱明阳[2] 卞洪亮[1] 

机构地区：[1]江苏省盐城市妇幼保健院儿科(心血管),江苏盐城224002 [2]广东省心血管病研究所心儿科广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2015年第3期334-337,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨小儿经导管封堵膜周部室间隔缺损(ventricular septal defect,VSD)术后发生左束支传导阻滞的原因、预防及治疗。方法对631例经超声心动图和造影检查证实膜周部VSD,且具有介入治疗适应证的患者进行导管堵闭手术,对术后出现左束支或左前分支传导阻滞进行相应治疗和早期随访。结果术中新发生左束支及左前分支传导阻滞6例,予以甲强龙2 mg/kg静脉注射,心电图均恢复正常后继续介入治疗。术后共计发生8例(1.26%)左束支传导阻滞,11例(1.74%)左前分支传导阻滞。其中术后1 d内发生左束支传导阻滞6例,左前分支传导阻滞8例,给予相应处理后其中左束支传导阻滞4例恢复正常,2例无恢复(经心外科治疗后恢复正常);左前分支传导阻滞5例恢复正常。术后1个月新增发生2例左前分支传导阻滞,术后3个月新增1例左前分支传导阻滞。结论经导管封堵膜周部VSD术后发生左束支或左前分支传导阻滞的比例相对较低,术后早期发现并进行必要的干预可以减少外科手术,应加强中远期随访。Objectives To discuss the factor, prevention and treatment of left bundle branch block（LBBB） after transcatheter closure of perimembranous ventricular defect（PVSD） in children. Methods A total of 631 patients with PSVD diagnosed by echocardiography and cardiac catheterization undergoing transcatheter occlusion procedure were included in the study. Treatment and early follow-up of the patients with LBBB or left anterior bundle branch block（LABBB） after transcatheter closure of PVSD were analyzed. Results There were 6 patients with LBBB and LABBB during transcatheter occlusion procedure. When their heart rates recovered after intravenous injection of prednisolone（2 mg / kg）, the treatment was continued. There were 8 patients（1.26%） with LBBB and 11 patients（1.74%） with LABBB after the procedure. Of them, 6 patients with LBBB and 8 patients with LABBB occurred 1 d after the procedure. Four patients with LBBB and 5 patients with LABBB recovered after routine treatment and 2 patients with LBBB recovered after surgery. Two patients with LABBB occurred in 1 month and 1 patient with LABBB occurred in 3months. Conclusions After transcatheter occlusion of PVSD, the occurrence rates of LBBB or LABBB are low. Early discovery and timely treatment can reduce the rate of surgery. However, LBBB and LABBB need a mid- and long-term follow-up.

关 键 词：室间隔缺损 介入治疗 左束支传导阻滞 

分 类 号：R541.1[医药卫生—心血管疾病]