经导管主动脉瓣置入术围手术期完全性房室传导阻滞发生及治疗分析  

Analysis of occurrence and treatment of perioperative complete atrioventricular block by transcatheter aortic valve implantation

作　　者：徐红党 林洪启[1] 张戈军 潘湘斌 刘煜昊[3] 程兆云[4] 高传玉[4] 韩宇[3] Xu Hongdang;Lin Hongqi;Zhang Gejun;Pan Xiangbin;Liu Yuhao;Cheng Zhaoyun;Gao Chuanyu;Han Yu(Department of Anesthesiology of Henan Provincial People′s Hospital,Central China Fuwai Hospital,Zhengzhou University Central China Fuwai Hospital,Zhengzhou 451464,China;Department of Structural Heart Disease of Fuwai Hospital of the Chinese Academy of Medical Sciences National Center Cardiovascular Diseases,Beijing 100037,China;Department of Structural Heart Disease of Henan Provincial People′s Hospital,Central China Fuwai Hospital,Zhengzhou University Central China Fuwai Hospital,Zhengzhou 451464,China;Department of Cardiac Surgery of Henan Provincial People′s Hospital,Central China Fuwai Hospital Zhengzhou University Central China Fuwai Hospital,Zhengzhou 451464,China)

机构地区：[1]河南省人民医院,华中阜外医院,郑州大学华中阜外医院麻醉科,郑州451464 [2]中国医学科学院阜外医院,国家心血管中心结构性心脏病科,北京100037 [3]河南省人民医院,华中阜外医院,郑州大学华中阜外医院结构性心脏病科,郑州451464 [4]河南省人民医院,华中阜外医院,郑州大学华中阜外医院心外科,郑州451464

出　　处：《中华医学杂志》2021年第40期3323-3328,共6页National Medical Journal of China

基　　金：国家自然科学基金(81800287);河南省医学科技攻关计划(LHGJ20200104);河南省中青年卫生健康科技创新人才项目(YXKC2020047)。

摘　　要：目的分析经导管主动脉瓣置入术(TAVI)围手术期完全性房室传导阻滞(CAVB)发生和治疗情况。方法回顾性收集2017年10月至2021年5月河南省人民医院心脏中心经股动脉TAVI患者65例。记录患者围手术期资料,根据TAVI患者围手术期是否发生CAVB分成两组:CAVB组和非完全性房室传导阻滞组(NCAVB组)。采用多因素logistic回归模型分析经导管主动脉瓣置入术围手术期完全性房室传导阻滞的危险因素。记录两组围手术期并发症发生情况。结果65例患者年龄为(69.1±7.3)岁,其中男性35例,女性30例;CAVB组为15例,NCAVB组为50例。永久起搏器植入患者为14例。多因素分析显示,术前右束支传导阻滞[OR值(95%CI)为3.325(2.132~13.061),P=0.005],主动脉瓣严重钙化[OR值(95%CI)为1.271(1.052~3.326),P=0.030]是TAVI围手术期CAVB的相关因素。CAVB组永久性起搏器植入率为11/15(11例),高于NCAVB组的6.0%(3例),差异具有统计学意义(P<0.001)。结论术前右束支传导阻滞、主动脉瓣严重钙化是TAVI围手术期完全性房室传导阻滞的相关因素。CAVB组永久性起搏器植入率较高。Objective To retrospectively analyze the occurrence and treatment of perioperative complete atrioventricular block(CAVB)by transcatheter aortic valve implantation(TAVI).Methods A total of 65 patients who underwent TAVI via femoral artery in the Heart Center of Henan People′s Hospital from October 2017 to May 2021 were enrolled.Perioperative data of patients were recorded.The patients were divided into two groups according to whether complete atrioventricular block was occurred during TAVI:complete atrioventricular block group(Group CAVB)and non-complete atrioventricular block group(Group NCAVB).Multivariate logistic regression model was used to analyze the risk factors of complete atrioventricular block during transcatheter aortic valve implantation.The incidence of perioperative complications were recorded.Results The patients age was(69.1±7.3)years old.and there were 35 males and 30 femals.There were 15 patients in group CAVB with complete atrioventricular block and 50 patients in group NCAVB.Multivariate analysis showed that preoperative right bundle branch block[OR(95%CI)vs 3.325(2.132-13.061),P=0.005]and severe aortic valve calcification[OR(95%CI)vs 1.271(1.052-3.326),P=0.030]were independent correlative factors for CAVB during TAVI perioperative period.The implantation rate of permanent pacemaker in group CAVB was 73.3%(11 cases),which was higher than 6.0%(3 cases)in group NCAVB(P<0.001).Conclusions It indicated that preoperative right bundle branch block and severe aortic valve calcification are correlative factors for complete atrioventricular block for TAVI.The implantation rate of permanent pacemaker in complete atrioventricular block group increased significantly.

关 键 词：房室传导阻滞 围手术期 经导管主动脉瓣植入术 

分 类 号：R654.2[医药卫生—外科学]