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目的探讨儿童膜部室间隔缺损(pmVSD)介入治疗时心脏传导阻滞发生的原因及防治措施。方法选择2002年10月至2008年8月在本院成功接受介入治疗的328例pmVSD患儿为研究对象,其中男159例,女169例,年龄1.5~14岁,平均(6.2±3.8)岁,分别于介入治疗术前1d及术后第4天记录12导同步心电图及24h动态心电图,术中持续心电监护,由心电专业人员进行分析,得出各型心脏传导阻滞的检出情况。结果(1)328例pmVSD患儿介入术后新发心脏传导阻滞27例(占8.2%),其中Ⅱ~Ⅲ°房室传导阻滞(AVB)9例,3例为术中操作导管刺激pmVSD周围组织所致,6例为迟发性Ⅱ~Ⅲ度AVB。经静脉应用大剂量氢化可的松等治疗后27例完全恢复正常,1例遗留IRBBB,1例遗留CRBBB。(2)pmVSD介入治疗术后新发心脏传导阻滞患儿与对照组比较,VSD内径与封堵器直径差值较对照组明显大〔(2.8±0.9)mm与(2.0±0.7)mm,P<0.01〕。结论VSD介入治疗后发生的迟发性Ⅲ度AVB可能与所选用封堵器偏大有关,激素治疗有效,预后一般良好。
Objective To investigate the causes and prevention measures of heart block during interventional therapy of ventricular septal defect (pmVSD) in children. Methods A total of 328 children with pmVSD admitted to our hospital from October 2002 to August 2008 were selected as the study subjects, including 159 males and 169 females, aged 1.5-14 years (mean, 6.2 ± 3.8 years) , Respectively, 12d ECG and 24h Holter were recorded on the first day before PCI and the 4th day after PCI. ECG was monitored during the operation, and ECGs were analyzed by ECG professionals. Various types of cardiac conduction block were detected Happening. Results (1) Among 328 cases of children with pmVSD, 27 cases (8.2%) had new heart block after PCI, including 9 cases of Ⅱ ~ Ⅲ ° atrioventricular block (AVB) and 3 cases of intraoperative catheterization pmVSD surrounding tissue caused by 6 cases of delayed Ⅱ ~ Ⅲ degree AVB. After the intravenous application of high-dose hydrocortisone and other treatment, 27 cases returned to normal completely, 1 case left with IRBBB and 1 case left with CRBBB. (2) Compared with the control group, the difference between the diameter of VSD and the diameter of occluder in children with newly diagnosed heart block after pmVSD intervention was significantly (2.8 ± 0.9) mm and (2.0 ± 0.7) mm, P <0.01〕. Conclusions Delayed grade III AVB after VSD intervention may be related to the overstage of the occluder selected. Hormone therapy is effective and the prognosis is generally good.