先天性心脏病心内直视术后－过性Ⅲ度房室传导阻滞

Transient Ⅲ°Atrioventricular Block After Open-heart Surgery for Congenital Heart Disease

目的：了解先天性心脏病（先心病）心内直视术后出现一过性Ⅲ度房室传导阻滞（ＡＶＢ）的转归及其处理，为该并发症的防治提供帮助。方法：对４２例先心病心内直视术后出现－过性Ⅲ度ＡＶＢ的患者进行分析，了解自主心律的转归情况和时间。结果：３６例先心病患者在术毕心脏复跳后即为Ⅲ度ＡＶＢ；６例在平均术后４．８天（０．５～１３．０天）出现Ⅲ度ＡＶＢ。４２例中１４例（３３．３％）在自主性窦性心律恢复当天即变为稳定的窦性心律；２８例（６６．７％）需要平均８．８天（１～８１天）的窦性心律与传导阻滞心律的交替过程。变为稳定的窦性心律时间为术后平均１１．７天（０．５～８１．０天）。３例术后死于与Ⅲ度ＡＶＢ无关的并发症。结论：心内直视术后－过性Ⅲ度ＡＶＢ的产生原因主要为术中损伤传导系统造成局部出血、水肿所致。出现Ⅲ度ＡＶＢ，应先安置临时起搏器，帮助自主心律的转复。

Objective :To assess the reversion and management of transient Ⅲ° atrioventricular block after open-heart surgery for congenital heart disease(CHD).Methods: Forty-two patients with transient Ⅲ°atrioventricular block(AVB) after open-heart surgery for CHD were analysed to study the time of reversion to normal sinus rhythm and the management.Results:Thirty-Six patients developed Ⅲ°intraoperatively,and 6 patients within 4.8(0.5-13.0 days).14 of the 42 cases(33.3%)resumed normal sinus rhythm on the day of operation,while 28 (66.7%)on the 8. 8th (1-81 th)day with a period of alterating AVB and sinus rhythm. The mean duration of transient Ⅲ° AVB was 11.7(0.5-81.0) days. 3 patients died of postoperative complications unrelated to heart block.Conclusion:Transient AVB is caused by damage of the conductive system during operation. Temporary pacemaker should be implantedto help the patients over Ⅲ° AVB.