儿童室间隔缺损介入封堵术后心律失常及其危险因素分析
发布时间：2018-08-09 18:31
【摘要】：目的探讨室间隔缺损(VSD)介入堵闭术后心律失常及其危险因素,评价VSD介入堵闭术的安全性和疗效。方法回顾分析2014年1月~2016年12月在重庆医科大学附属儿童医院心血管内科行VSD介入堵闭术患者的临床表现、心电图(ECG)及/或动态心电图、超声心动图(Transthoracic echocardiography,TTE)等术前检查、术中操作及心电监测,以及术后复查随访资料。分析其中成功行VSD堵闭术的患儿术后发生心律失常情况及其危险因素。结果1.2014年1月~2016年12月所有在重庆医科大学附属儿童医院心血管内科行VSD介入堵闭术的患者共381例,其中男性186例(48.8%),女性195例(51.2%),年龄1岁2月-16岁(3岁7月±2岁)。本研究381例行室间隔缺损介入堵闭术患者中,有367例堵闭成功,成功率为96.3%。无死亡病例。其中有14例封堵失败,原因包括:室间隔缺损的解剖位置太高,靠近主动脉瓣,介入风险大,放弃封堵的有4例;置入室间隔缺损堵闭器后,造影结果显示主动脉瓣的反流加重的有4例;缺损大,封堵后仍有较大残余分流的有4例;术中造影显示VSD缺损处分流太小,导丝无法通过而成功封堵的有2例。2.成功行VSD堵闭术的367例患者中,有84例术后发生心律失常,占22.89%。包括传导阻滞有58例,占69%,其中不完全性右束支传导阻滞有32例,占38.1%;完全性右束支传导阻滞(CRBBB)有8例,占9.5%;完全性左束支传导阻滞(CLBBB)有1例,占1.19%;左前分支阻滞(LAFB)有10例,占11.9%;房室传导阻滞(AVB)共6例,分别为Ⅰ度房室传导阻滞(Ⅰ°AVB)3例(3.57%)、Ⅱ度房室传导阻滞(Ⅱ°AVB)1例(1.19%),Ⅲ度房室传导阻滞(Ⅲ°AVB)1例(1.19%),Ⅰ°AVB合并室内传导阻滞1例(1.19%),发生率为7.14%;起源异常类型的心律失常有26例(31%),包括结性逸搏9例(10.71%),频发房性早搏7例(8.33%),频发室性早搏3例(3.57%),非阵发性结性心动过速3(3.57%),游走心律2例(2.38%),交界性逸搏1例(1.19%),非阵发性结性心动过速合并干扰性房室脱节1(1.19%);严重心律失常(包括Ⅱ°AVB、Ⅲ°AVB、CLBBB)有3例,占3.57%,各有1例。3.术前有无心律失常、是否合并膜部瘤、手术时间长短、室间隔缺损直径大小、堵闭器直径大小与介入术后心律失常的发生具有相关性(P0.05)。而堵闭器的类型、患儿手术时年龄、室间隔缺损上缘到主动脉瓣的距离与心律失常的发生没有明显相关性(P0.05)。4.出院时复查心电图显示36例已恢复正常(36/84,42.9%),但有48例仍未消失。术后3例严重心律失常,经过静脉甲强龙、白蛋白、地塞米松输注疗后在出院时:(1)1例Ⅲ°AVB转变为Ⅰ°AVB;(2)1例Ⅱ°AVB转变为LAFB;(3)1例CLBBB转变为不完全性左束支传导阻滞。26例起源异常类的心律失常在VSD介入术后给予糖皮质激素减轻水肿,在1周内均恢复正常。结论1.心律失常是行VSD堵闭术后比较常见的一种并发症,其中以不完全性右束支传导阻滞(IRBBB)最多见,而严重心律失常的发生占少数。2.术前有无心律失常、否合并膜部瘤、室间隔缺损的直径大小、封堵器直径大小、手术时间长短与VSD介入堵闭术后心律失常的发生具有密切的相关性。所以,我们应该在术前了解VSD的解剖形态、严格遵守手术适应症、依据VSD直径来选择适宜的封堵器、术中尽量缩短手术时间,以减少VSD介入堵闭术后心律失常的发生。3.及时发现并规范治疗,室间隔缺损介入堵闭术后心律失常预后情况较好。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
本文编号：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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4
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