先天性心脏病术后完全性房室传导阻滞的防治

Prevention and Treatment of Complete Atrioventricular Block after Open Heart Surgery for Congenital Heart Disease.

目的探讨１７５４例先天性心脏病直视术后１０例完全性房室传导阻滞（ＣＡＶＢ）的发生原因和转归，提出正确的防治方案。方法手术中立即发生ＣＡＶＢ８例；其中６例立即再次阻断主动脉重新修补，２例使用心外膜起搏和异丙肾上腺素处理，其中１例术后第７天再次手术重新修补缺损；手术后３～４天由于ＣＡＶＢ发生心源性昏厥２例，均安置临时心内膜起搏器。结果全组患者无住院死亡，全部康复出院未留置永久性心内膜起搏器。结论ＣＡＶＢ的发生与房间隔缺损（ＡＳＤ）、室间隔缺损（ＶＳＤ）的位置和手术操作有关；正确认识房室传导组织的解剖是防止损伤的关键，术中一旦发生ＣＡＶＢ应果断拆除原修补缝线，重新修补缺损；术后安置心外膜或心内膜临时起搏器对防止心源性昏厥非常有效。

Objective To explore the cause and the longterm result of complete atrioventricular block(CAVB) after open heart surgery and to present correct methods of prevention and treatment. Methods Ten patients with postoperative CAVB were studied. Eight patients occured CAVB during operation, six of them were reoperated immediately, and other two were treated with temporary epicardium pacemaker but one of the two was reoperated on 7th day after first surgery. Two patients had late onset of CAVB which appear as StokesAdams attack 3 to 4 days after surgery and were treated with temporary endocardium pacemaker. Results There was no postoperative mortality. All patients recovered normally and did not require permanent cardiac pacemaker. Conclusion The authors conclude that the incidence of CAVB is related to types of septal defect and technique of surgery. To prevent CAVB, it is important to fully understand the surgical anatomy of atrioventricular conducting tissue and its relationship to the defect. Whenever CAVB was present during surgery, it is right to reoperate and repair the defect with correct method. In order to prevent postoperative StokesAdams attack, temporary pacemaker should be placed. The late onset of CAVB is not require reoperation and has better result.