小儿先天性室间隔缺损介入治疗心电改变及处理

Change of electrocardiogram and treatment in the children with congenital ventricular septal defect by interventional processes

目的分析小儿先天性室间隔缺损（VSD）介入治疗后的心电图（ECG）变化，探索避免严重心律失常的发生。方法记录260例介入封堵VSD术前后的ECG，据此分成术后心律失常组和无心律失常组（对照组），对发生完全性或重度房室传导阻滞（AVB）的患儿及时营养心肌和减轻心肌水肿治疗，必要时放置临时起搏器。结果心律失常组82例（31．5％），对照组178例。心律失常组中4例（1．5％）为完全性或重度AVB。36例（13．8％）给予营养心肌等药物处理。两组VSD径比较无显著差异（P〉0．05）；心律失常组较对照组年龄小，体质量轻（P〈0．05），选用封堵器较对照组大（P〈0．05）。心率、QRS时限、PR间期、QT间期和QTc封堵术前后差异有统计学意义（P〈0．05）。结论VSD介入封堵术中和术后需密切注意ECG改变，避免选择过大封堵器。出现完全性右束支传导阻滞（CRBBB）、完全性左束支传导阻滞（CLBBB）、二度AVB者，应尽早营养心肌治疗；完全性或重度AVB者，尽早安装临时起搏器。

Objective To analysis the change of electrocardiogram（ ECG） in the children with congenital ventricular septal defect（VSD） by interventional processes and to explore how to decrease the incidence of serious arrhythmias. Methods To record the ECG before and after interventional closure in the 260 patients that hey were divided into arrhythmia group and no arrhythmia group（ control group）. The patients were treated with nutrition of cardiac muscle and medicines of reducing the cardiac muscle dropsy when they suffered from complete or serious complete or severe atrioventricular block （ AVB ） even underwent the temporary pacemaker quickly. Results There were 178 cases in control group. 82 cases（31.5% ） had arrhythmias after the interventional, in which 4 cases （ 1.5 % ）were complete/serious AVB. 36 cases （ 13.8 % ） were given medicine above. The age was smaller and the body weigh was less in the arrhythmia group than that of control group（P 〈0. 05）. The device occluder was bigger in the arrhythmia group than that of control group （P 〈 0.05. There were significant differences in the comparison of the heart rate, QRS interval, PR interval, QT interval and QTc before and after occlusion in all the cases （P 〈 0. 05 ）. Conclusion The changes of ECG have to be taken attention when underwent transcatheter VSD closure using. It is important to avoid the oversized devices. When complete right branch bundle block（ CRBBB ） , complete left branch bundle block （CLBBB）and second AVB occur in the procedure or after that, medicine should be given as early as possible, and once complete/serious AVB has emerged, it is much helpful to perform the temporary pacemaker. All of the cases with arrhythmia should be long-term followed- up.