经导管主动脉瓣置入术围手术期发生完全性房室传导阻滞的影响因素和治疗研究  

Factors and Treatment of Occurrence of Complete Atrioventricular Block During Transcatheter Aortic Valve Implantation in Perioperative Period

作　　者：闫国伟[1] YAN Guowei(Department of Cardiovascular Medicine,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院心血管内科,河南洛阳471000

出　　处：《临床研究》2022年第11期1-4,共4页Clinical Research

摘　　要：目的探究经导管主动脉瓣置入术围手术期间完全性房室传导阻滞发生因素及治疗方式。方法针对河南科技大学第一附属医院2020年1月至2021年12月收治的60例经股动脉导管主动脉瓣置入术患者,回顾其临床资料(性别、年龄、体质指数,是否伴有糖尿病、高血压,手术前室内传导阻滞、手术前Ⅰ度房室传导阻滞、手术前窦性心动过缓、陈旧心梗、术前右束支传导阻滞或者QRS波增宽、主动脉瓣重度钙化、瓣膜置入过深)。结合经导管主动脉瓣置入手术患者围手术期有无完全性房室传导阻滞出现,将其划分成出现组和未出现组。比较发生组与未发生组的治疗情况、并发症及临床指标。结果在60例患者中,出现完全性房室传导阻滞者有10例(16.67%),未出现完全性房室传导阻滞者有50例(83.33%)。出现组与未出现组患者在陈旧心梗、术前右束支传导阻滞或者QRS波增宽、主动脉瓣重度钙化、瓣膜置入过深方面比较,差异有统计学意义(P<0.05)。手术前右束支传导阻滞及主动脉瓣重度钙化是影响经导管主动脉瓣置入术围手术期发生完全性房室传导阻滞的危险因素,差异有统计学意义(P<0.05)。两组患者急性肺损伤、急性肾损伤、短暂性神经功能障碍及永久性神经功能障碍出现率对比,差异无统计学意义(P>0.05)。出现组永久性起搏器植入率相较高于未出现组,差异有统计学意义(P<0.05)。两组患者住院时间、ICU停留时间及机械通气时间对比,差异无统计学意义(P>0.05)。结论手术前右束支传导阻滞及主动脉瓣重度钙化是影响经导管主动脉瓣置入围术期完全性房室传导阻滞出现的主要因素,对发生完全性房室传导阻滞的患者,可采用永久性起搏器植入治疗。Objective To analyze the influence factors and treatment modes of the complete atrioventricular block during the transcatheter aortic valve implantation.Methods A total of 60 patients who underwent transcatheter aortic valve implantation admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 2020 to December 2021 were selected.The general data were acquired,including the patient’s gender,age,body mass index,diabetes mellitus,hypertension,preoperative intraventricular block,type I atrioventricular block,preoperative sinus bradycardia,old myocardial infarction,preoperative QRS wave broadening/right bundle branch block,severe aortic valve calcification and deep valve implantation.According to the perioperative occurrences of the complete atrioventricular block during the transcatheter aortic valve implantation,patients were assigned to the occurrence group and nonoccurrence group.The treatment conditions,complications,and clinical indicators between the occurrence group and the nonoccurrence group were compared.Results Among the 60 patients,10 patients were found with a complete atrioventricular block(16.67%)and 50 patients without a complete atrioventricular block(83.33%).There were significant differences in the old myocardial infarction,preoperative QRS wave broadening/right bundle branch block,severe aortic valve calcification,and deep valve implantation between the occurrence group and nonoccurrence group(P<0.05);The risk factors of the complete atrioventricular block included the preoperative right bundle branch block and severe aortic valve calcification,the differences were statistically significant(P<0.05);There were no significant between-group differences about the acute lung injury,acute kidney injury,transient nerve dysfunction and permanent nerve dysfunction(P>0.05);The permanent pacemaker implantation rate in occurrence group was higher than nonoccurrence group,with statistically significant difference(P<0.05);There were no significant between-group diff

关 键 词：围手术期 完全性房室传导阻滞 经导管主动脉瓣置入术 起搏器 钙化 右束支传导阻滞 

分 类 号：R654.2[医药卫生—外科学]