经导管膜周部室间隔缺损介入治疗并发症及危险因素分析  

Complications and risk factors of transcatheter occlusion of perimembranous ventricular septal defects

作　　者：韩咏 李俊杰[2] 王树水[2] 张智伟[2] 钱明阳[2] 谢育梅[2] HAN Yong;LI Jun-jie;WANG Shu-shui;ZHANG Zhi-wei;QIAN Ming-yang;XIE Yu-mei(Department of Peadatric Cardiology,Liuzhou Maternal and Child Health Hospital,Liuzhou 545001,China)

机构地区：[1]柳州市妇幼保健院心儿科,广西柳州545001 [2]广东省人民医院广东省心血管病研究所心儿科

出　　处：《中国介入心脏病学杂志》2020年第8期445-450,共6页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划项目(2016YFC1100300)。

摘　　要：目的探讨经导管膜周部室间隔缺损(PMVSD)介入治疗并发症及影响早期并发症的危险因素。方法收集2011年1月至2016年12月在广东省人民医院接受介入治疗的PMVSD患者临床资料,统计早期和晚期并发症类型及发生率。将患者分为有、无早期并发症组,有、无心律失常组,有、无主动脉瓣反流组,有、无三尖瓣反流组,采用logistic多因素回归分析与各组并发症有关的危险因素。结果在完成室间隔缺损(VSD)封堵术的1288例中,出现各类早期并发症148例,总发生率为11.5%。按并发症种类统计,心律失常85例(6.6%),主动脉瓣反流(AR)20例(1.6%),三尖瓣反流(TR)36例(2.8%),其他并发症7例(0.5%)。按并发症程度统计,严重并发症31例(2.4%),轻微并发症117例(9.1%),包括右束支传导阻滞64例(5.0%)、轻度AR 19例(1.5%)、轻度TR 34例(2.6%),均无需特殊处理。logistic多因素回归分析显示:手术时间(OR 1.025,95%CI 1.012~1.038,P<0.001)、封堵器直径(OR 1.225,95%CI 1.102~1.361,P<0.001)、年龄(OR 0.532,95%CI 0.356~0.793,P=0.002)是封堵术后早期并发症发生的危险因素;封堵器直径(OR 1.224,95%CI 1.068~1.404,P=0.004)和合并肺动脉高压(OR 0.183,95%CI 0.074~0.456,P<0.001)是术后心律失常发生的危险因素;手术时间(OR 1.041,95%CI 1.022~1.060,P<0.001)和VSD直径(OR 1.436,95%CI 1.192~1.730,P<0.001)为术后TR发生的危险因素;手术时间(OR 1.042,95%CI 1.005~1.081,P=0.025)是术后AR发生的危险因素。结论PMVSD介入治疗并发症主要以轻微并发症为主;年龄小、手术时间过长、VSD直径过大以及使用直径较大封堵器与多种并发症的发生密切相关,严格把握适应证和规范操作可降低早期并发症的发生;晚期并发症的情况需进行长期严格的随访。Objective To analyze the risk factors of complications after perimembranous ventricular septal defect(PMVSD)transcatheter closure.Methods From January 2011 to December 2016,patients with PMVSD who underwent transcatheter closure in our hospital were enrolled in the study.The types and incidence of the complications were reviewed,and the risk factors of the complications were analyzed.Patients were divided into 4 groups(according to with or without operative complications,arrhythmia,tricuspid regurgitation(TR),and aortic regurgitation(AR).Multivariate logistic regression was used to analyze the risk factors related to complications.Results Procedure was successful in 1288 cases.The early complications rate was 11.5%(148/1288),including 85(6.6%)of arrhythmia,20(1.6%)of AR,36(2.8%)of TR,and 7(0.5%)of others.Major complications occurred in 31 patients(2.4%)and minor in 117 patients(9.1%),including 64(5.0%)of right bundle branch block(RBBB),19(1.5%)of minor AR and 34(2.6%)of minor TR,which were all no need to treat.Multivariate logistic regression suggested that procedure time(OR 1.025,95%CI 1.012–1.038,P<0.001),device size(OR 1.225,95%CI 1.102–1.361,P<0.001)and age(OR 0.532,95%CI 0.356–0.793,P=0.002)were independent risk factors aff ecting the occurrence of the early complications.Device size(OR 1.224,95%CI 1.068–1.404,P=0.004)and pulmonary hypertension(OR 0.183,95%CI 0.074–0.456,P<0.001)were risk factors aff ecting the occurrence of postoperative arrhythmia;Operation time(OR 1.041,95%CI 1.022–1.060,P<0.001)and diameter of VSD(OR 1.436,95%CI 1.192–1.730,P<0.001)were risk factors aff ecting the occurrence of postoperative TR;Operation time(OR 1.042,95%CI 1.005–1.081,P=0.025)was risk factors affecting the occurrence of postoperative AR.Conclusions Minor complications possess a dominant status in all complications after transcatehter closure of the PMVSD,young age,long operation time,large VSD and large occluder device are closely related to the early complications,operative indication and standard opera

关 键 词：膜周部室间隔缺损 心脏导管插入术 并发症 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病] R726.5[医药卫生—内科学]