兒童室間隔缺損介入封堵術后心律失常及其危險因素分析
發(fā)布時間：2018-08-09 18:31
【摘要】：目的探討室間隔缺損(VSD)介入堵閉術后心律失常及其危險因素,評價VSD介入堵閉術的安全性和療效。方法回顧分析2014年1月~2016年12月在重慶醫(yī)科大學附屬兒童醫(yī)院心血管內(nèi)科行VSD介入堵閉術患者的臨床表現(xiàn)、心電圖(ECG)及/或動態(tài)心電圖、超聲心動圖(Transthoracic echocardiography,TTE)等術前檢查、術中操作及心電監(jiān)測,以及術后復查隨訪資料。分析其中成功行VSD堵閉術的患兒術后發(fā)生心律失常情況及其危險因素。結(jié)果1.2014年1月~2016年12月所有在重慶醫(yī)科大學附屬兒童醫(yī)院心血管內(nèi)科行VSD介入堵閉術的患者共381例,其中男性186例(48.8%),女性195例(51.2%),年齡1歲2月-16歲(3歲7月±2歲)。本研究381例行室間隔缺損介入堵閉術患者中,有367例堵閉成功,成功率為96.3%。無死亡病例。其中有14例封堵失敗,原因包括:室間隔缺損的解剖位置太高,靠近主動脈瓣,介入風險大,放棄封堵的有4例;置入室間隔缺損堵閉器后,造影結(jié)果顯示主動脈瓣的反流加重的有4例;缺損大,封堵后仍有較大殘余分流的有4例;術中造影顯示VSD缺損處分流太小,導絲無法通過而成功封堵的有2例。2.成功行VSD堵閉術的367例患者中,有84例術后發(fā)生心律失常,占22.89%。包括傳導阻滯有58例,占69%,其中不完全性右束支傳導阻滯有32例,占38.1%;完全性右束支傳導阻滯(CRBBB)有8例,占9.5%;完全性左束支傳導阻滯(CLBBB)有1例,占1.19%;左前分支阻滯(LAFB)有10例,占11.9%;房室傳導阻滯(AVB)共6例,分別為Ⅰ度房室傳導阻滯(Ⅰ°AVB)3例(3.57%)、Ⅱ度房室傳導阻滯(Ⅱ°AVB)1例(1.19%),Ⅲ度房室傳導阻滯(Ⅲ°AVB)1例(1.19%),Ⅰ°AVB合并室內(nèi)傳導阻滯1例(1.19%),發(fā)生率為7.14%;起源異常類型的心律失常有26例(31%),包括結(jié)性逸搏9例(10.71%),頻發(fā)房性早搏7例(8.33%),頻發(fā)室性早搏3例(3.57%),非陣發(fā)性結(jié)性心動過速3(3.57%),游走心律2例(2.38%),交界性逸搏1例(1.19%),非陣發(fā)性結(jié)性心動過速合并干擾性房室脫節(jié)1(1.19%);嚴重心律失常(包括Ⅱ°AVB、Ⅲ°AVB、CLBBB)有3例,占3.57%,各有1例。3.術前有無心律失常、是否合并膜部瘤、手術時間長短、室間隔缺損直徑大小、堵閉器直徑大小與介入術后心律失常的發(fā)生具有相關性(P0.05)。而堵閉器的類型、患兒手術時年齡、室間隔缺損上緣到主動脈瓣的距離與心律失常的發(fā)生沒有明顯相關性(P0.05)。4.出院時復查心電圖顯示36例已恢復正常(36/84,42.9%),但有48例仍未消失。術后3例嚴重心律失常,經(jīng)過靜脈甲強龍、白蛋白、地塞米松輸注療后在出院時:(1)1例Ⅲ°AVB轉(zhuǎn)變?yōu)棰瘛鉇VB;(2)1例Ⅱ°AVB轉(zhuǎn)變?yōu)長AFB;(3)1例CLBBB轉(zhuǎn)變?yōu)椴煌耆宰笫鲗ё铚?6例起源異常類的心律失常在VSD介入術后給予糖皮質(zhì)激素減輕水腫,在1周內(nèi)均恢復正常。結(jié)論1.心律失常是行VSD堵閉術后比較常見的一種并發(fā)癥,其中以不完全性右束支傳導阻滯(IRBBB)最多見,而嚴重心律失常的發(fā)生占少數(shù)。2.術前有無心律失常、否合并膜部瘤、室間隔缺損的直徑大小、封堵器直徑大小、手術時間長短與VSD介入堵閉術后心律失常的發(fā)生具有密切的相關性。所以,我們應該在術前了解VSD的解剖形態(tài)、嚴格遵守手術適應癥、依據(jù)VSD直徑來選擇適宜的封堵器、術中盡量縮短手術時間,以減少VSD介入堵閉術后心律失常的發(fā)生。3.及時發(fā)現(xiàn)并規(guī)范治療,室間隔缺損介入堵閉術后心律失常預后情況較好。
[Abstract]:Objective to investigate the arrhythmia and its risk factors after interventional occlusion of ventricular septal defect (VSD) and evaluate the safety and efficacy of VSD interventional occlusion. Methods the clinical manifestations, electrocardiogram (ECG) and / or dynamic electrocardiogram (ECG) and / or dynamic electrocardiography were reviewed and analyzed in the cardiovascular department of the Affiliated Children's Hospital of Medical University Of Chongqing in December, January 2014. Drawings, Transthoracic echocardiography (TTE), preoperative examination, intraoperative and electrocardiographic monitoring, and postoperative review of follow-up data. The arrhythmia and its risk factors after the successful operation of VSD closure were analyzed. Results all the children's Hospital Affiliated to Medical University Of Chongqing, January ~ December 2016, was 1.2014 years. 381 cases of VSD interventional occlusion were performed in the cardiovascular medicine department, including 186 men (48.8%), 195 women (51.2%), aged 1 years old (3 years old and July + 2 years). In this study, 367 cases were successfully blocked and the success rate was 96.3%. without death in 381 patients with ventricular septal defect interventional occlusion. Among them, 14 cases of closure failed, including interventricular failure. The anatomical position of the septal defect was too high, close to the aortic valve, the intervention risk was large, and 4 cases were given up. After the closure of the ventricular septal defect, the results showed that there were 4 cases of the reflux of the aortic valve; the defect was large and there were 4 cases of large residual shunt after closure; the intraoperative angiography showed that the flow of VSD defect was too small and the guide wire was unable to pass through. Of the 367 cases of successful closure of.2., of 2 patients with successful VSD closure, 84 had arrhythmia after operation, accounting for 58 cases of 22.89%. including 69%, including 32 incomplete right bundle branch block (38.1%), 8 complete right bundle branch block (CRBBB), 9.5%, and 1 complete left bundle branch block (CLBBB). 1.19%, 10 cases of left anterior branch block (LAFB), 6 cases of atrioventricular block (AVB), 3 cases (3.57%) of I degree atrioventricular block (AVB), 1 (1.19%) atrioventricular block (1.19%), 1 cases (1.19%) of atrioventricular block (AVB) and 1 cases (1.19%) with I degree AVB combined with conduction block, occurrence rate of 7.14%; origin, 7.14%; origin Abnormal types of arrhythmia were found in 26 cases (31%), including 9 cases (10.71%), 7 cases of frequent atrial premature beat (8.33%), 3 cases of frequent ventricular premature beat (3.57%), 3 (3.57%) of non paroxysmal tachycardia, 2 cases of wandering heart rhythm, 1 cases of borderline escape, non paroxysmal tachycardia combined with interfering atrioventricular dislocation. There were 3 cases of arrhythmia (including II AVB, III AVB, CLBBB), accounting for 3.57%. There were 1 cases of no arrhythmia before.3., whether or not the membranous tumor was combined, the time of operation, the diameter of the ventricular septal defect, the diameter of the interventricular septal defect, and the incidence of arrhythmia after the interventional procedure (P0.05). There was no significant correlation between the distance from the upper edge of the defect to the aortic valve (P0.05) and the occurrence of arrhythmia (P0.05). The reexamination of electrocardiogram (ECG) at the discharge of.4. showed that 36 cases had been restored to normal (36/84,42.9%), but 48 cases were still not disappearing. 3 cases of severe arrhythmia after operation, after the infusion of intravenous methylprednisolone, albumin, and dexamethasone were discharged after the discharge: (1) 1 cases of III AVB transformation (2) (2) 1 cases of II degree AVB transformation to LAFB; (3) 1 cases of CLBBB transformation to incomplete left bundle branch block.26 cases of abnormal cardiac arrhythmia after VSD intervention to give glucocorticoid to reduce edema, in 1 weeks to restore normal. Conclusion 1. arrhythmia is a common complication after VSD closure, which is incomplete. The sexual right bundle branch block (IRBBB) is the most common, and the occurrence of serious arrhythmia is not associated with the arrhythmia before the operation of a few.2., the size of the ventricular septal defect, the diameter of the ventricular septal defect, the size of the occluder, the length of the operation and the occurrence of arrhythmia after the VSD intervention. Therefore, we should be before the operation. The anatomical morphology of VSD was solved, the surgical indications were strictly observed, the appropriate occluder was selected according to the diameter of VSD, and the operation time was shortened as far as possible in order to reduce the occurrence of arrhythmia after VSD intervention and to standardize the treatment of.3., and the prognosis of arrhythmia after interventricular septal defect intervention was better.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.4
本文編號：2174937
[Abstract]:Objective to investigate the arrhythmia and its risk factors after interventional occlusion of ventricular septal defect (VSD) and evaluate the safety and efficacy of VSD interventional occlusion. Methods the clinical manifestations, electrocardiogram (ECG) and / or dynamic electrocardiogram (ECG) and / or dynamic electrocardiography were reviewed and analyzed in the cardiovascular department of the Affiliated Children's Hospital of Medical University Of Chongqing in December, January 2014. Drawings, Transthoracic echocardiography (TTE), preoperative examination, intraoperative and electrocardiographic monitoring, and postoperative review of follow-up data. The arrhythmia and its risk factors after the successful operation of VSD closure were analyzed. Results all the children's Hospital Affiliated to Medical University Of Chongqing, January ~ December 2016, was 1.2014 years. 381 cases of VSD interventional occlusion were performed in the cardiovascular medicine department, including 186 men (48.8%), 195 women (51.2%), aged 1 years old (3 years old and July + 2 years). In this study, 367 cases were successfully blocked and the success rate was 96.3%. without death in 381 patients with ventricular septal defect interventional occlusion. Among them, 14 cases of closure failed, including interventricular failure. The anatomical position of the septal defect was too high, close to the aortic valve, the intervention risk was large, and 4 cases were given up. After the closure of the ventricular septal defect, the results showed that there were 4 cases of the reflux of the aortic valve; the defect was large and there were 4 cases of large residual shunt after closure; the intraoperative angiography showed that the flow of VSD defect was too small and the guide wire was unable to pass through. Of the 367 cases of successful closure of.2., of 2 patients with successful VSD closure, 84 had arrhythmia after operation, accounting for 58 cases of 22.89%. including 69%, including 32 incomplete right bundle branch block (38.1%), 8 complete right bundle branch block (CRBBB), 9.5%, and 1 complete left bundle branch block (CLBBB). 1.19%, 10 cases of left anterior branch block (LAFB), 6 cases of atrioventricular block (AVB), 3 cases (3.57%) of I degree atrioventricular block (AVB), 1 (1.19%) atrioventricular block (1.19%), 1 cases (1.19%) of atrioventricular block (AVB) and 1 cases (1.19%) with I degree AVB combined with conduction block, occurrence rate of 7.14%; origin, 7.14%; origin Abnormal types of arrhythmia were found in 26 cases (31%), including 9 cases (10.71%), 7 cases of frequent atrial premature beat (8.33%), 3 cases of frequent ventricular premature beat (3.57%), 3 (3.57%) of non paroxysmal tachycardia, 2 cases of wandering heart rhythm, 1 cases of borderline escape, non paroxysmal tachycardia combined with interfering atrioventricular dislocation. There were 3 cases of arrhythmia (including II AVB, III AVB, CLBBB), accounting for 3.57%. There were 1 cases of no arrhythmia before.3., whether or not the membranous tumor was combined, the time of operation, the diameter of the ventricular septal defect, the diameter of the interventricular septal defect, and the incidence of arrhythmia after the interventional procedure (P0.05). There was no significant correlation between the distance from the upper edge of the defect to the aortic valve (P0.05) and the occurrence of arrhythmia (P0.05). The reexamination of electrocardiogram (ECG) at the discharge of.4. showed that 36 cases had been restored to normal (36/84,42.9%), but 48 cases were still not disappearing. 3 cases of severe arrhythmia after operation, after the infusion of intravenous methylprednisolone, albumin, and dexamethasone were discharged after the discharge: (1) 1 cases of III AVB transformation (2) (2) 1 cases of II degree AVB transformation to LAFB; (3) 1 cases of CLBBB transformation to incomplete left bundle branch block.26 cases of abnormal cardiac arrhythmia after VSD intervention to give glucocorticoid to reduce edema, in 1 weeks to restore normal. Conclusion 1. arrhythmia is a common complication after VSD closure, which is incomplete. The sexual right bundle branch block (IRBBB) is the most common, and the occurrence of serious arrhythmia is not associated with the arrhythmia before the operation of a few.2., the size of the ventricular septal defect, the diameter of the ventricular septal defect, the size of the occluder, the length of the operation and the occurrence of arrhythmia after the VSD intervention. Therefore, we should be before the operation. The anatomical morphology of VSD was solved, the surgical indications were strictly observed, the appropriate occluder was selected according to the diameter of VSD, and the operation time was shortened as far as possible in order to reduce the occurrence of arrhythmia after VSD intervention and to standardize the treatment of.3., and the prognosis of arrhythmia after interventricular septal defect intervention was better.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.4
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