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目的评价膜部室间隔缺损(VSD)治疗后心律失常的发生率和预后。方法对比分析2002年8月至2006年2月采用介入治疗膜部 VSD 患者358例(介入组)外科治疗手术组50例(手术组),治疗后和出院时的心电图心律失常改变,并对患者进行1、3、6和12个月连续随访。结果两组住院中除束支阻滞外,其他心律失常均在出院前消失。出院时介入组完全性右束支阻滞16例(4.5%),不完全性右束支阻滞36例(10.1%),左前半阻滞10例(2.8%),不完全性右束支阻滞并左前半阻滞6例(1.7%),完全性右束支阻滞并左前半阻滞2例(0.6%);而外科手术组完全性右束支阻滞和不完全性右束支阻滞分别为13例(26%)和14例(28%),显著高于介入组;随访1年时,介入组完全性右束支阻滞(3.3%)、不完全性右束支阻滞(3.3%)、完全性右束支阻滞并左前半阻滞(1.7%)和Ⅲ度房室传导阻滞(0.56%)明显得到改善,而外科手术组则无改善。介入组随访到180例,外科手术组随访50例。两组患者的性别、年龄、体重、膜部 VSD 大小、合并膜部膨出瘤的比例差异均无统计学意义(均 P>0.05)。结论两组治疗的临床效果一致,但是介入治疗比外科手术更安全;介入治疗产生的不完全性右束支阻滞和左前半阻滞,多在术后6～12个月消失,而完全性右束支阻滞或完全性右束支阻滞并左前半阻滞则需长期随访。
Objective To evaluate the incidence and prognosis of arrhythmia after membranous ventricular septal defect (VSD) treatment. Methods To compare and analyze the changes of electrocardiogram arrhythmia in 358 cases (intervention group) and 50 cases (intervention group) treated with interventional treatment of membranous VSD between August 2002 and February 2006. The changes of electrocardiogram arrhythmia after treatment and discharge were analyzed. One, three, six and twelve months follow-up. Results In addition to the bundle branch block in both groups, other arrhythmias disappeared before discharge. There were 16 cases (4.5%) of right bundle branch block, 36 cases (10.1%) of incomplete right bundle branch block, 10 cases (2.8%) of left anterior block, incomplete right bundle branch There were 6 cases (1.7%) with block and left anterior block, complete right bundle branch block with left anterior block in 2 cases (0.6%), while the complete right bundle branch block and incomplete right bundle The branch block was 13 (26%) and 14 (28%) cases, respectively, which were significantly higher than those of the intervention group. At the follow-up of 1 year, the right bundle branch block (3.3%), incomplete right bundle branch (3.3%), complete right bundle branch block with left anterior block (1.7%) and third degree atrioventricular block (0.56%) were significantly improved, while the surgical group did not improve. The intervention group was followed up to 180 cases, the surgical group were followed up 50 cases. There was no significant difference in the proportions of gender, age, body weight, size of VSD, and bulging tumor in the two groups (all P> 0.05). Conclusion The clinical effects of the two groups are the same, but the interventional treatment is safer than the surgery. The incomplete right bundle branch block and the left anterior block caused by interventional therapy mostly disappear 6 to 12 months after the operation, while the completeness Right bundle branch block or complete right bundle branch block with left anterior block requires long-term follow-up.