成人经导管堵闭膜周部室间隔缺损术后发生传导阻滞的临床研究

Atrioventricular block after interventional occlusion of ventricular septal defect in adult patients

目的探讨成人经导管堵闭膜周部室间隔缺损(VSD)术后传导阻滞的发生比例及防治方法。方法对137例经超心动图声和造影检查证实且具有介入治疗适应证的膜周部VSD患者进行导管堵闭手术,术后即刻出现心律失常(如传导阻滞、交界性心律、心律减慢等)者(C组)予静脉注射地塞米松或经静脉泵注射肾上腺素。术后即刻未出现新发心律失常的患者分层随机进行对比研究:A组,常规静脉注射地塞米松10mg,每日1次,持续3d;B组,不做特殊处理,待心律失常出现持续24h后再据病情给予相应治疗。结果术后即刻38例患者出现传导阻滞,占27.9%;术后即刻99例患者未出现传导阻滞,占71.6%。A组传导阻滞的发生率和一过性传导阻滞的发生率分别为9.8%和5.9%,均显著低于B组的41.7%和27.5%(P值均<0.05)。结论经导管堵闭膜周部VSD术后新发传导阻滞的比例相对较高,术后7d内连续心电监护和预防性使用激素是必要的,且需要进行严密的随访。

Objective To discuss the prevalence and prevention ＆ therapy of atrioventricular block after interventional occlusion of ventricular septal defect（VSD） in adult patients. Methods Totally 137 patients with perimembranous VSD, who had the indications for interventional occlusion as showed by echocardiograghy and fluoroscopy, were treated with transcatheter intervention. Patients who had immediate post-operation arrhythmia （e. g. heart block, junctional rhythm, and slow rhythm, group C） were given intravenous dexamethasone or intravenous infusion of adrenalin, and those had no newly discovered arrhythmia with in 24 h after operation were divided into two groups according to the use of glucocorticoid： Group A; daily dexamethasone （ 10 mg, i. v. ） lasting for 3 days; Group B.. receiving no special treatment. Treatment was only given when arrhythmia lasted for 24 h after treatment. Results Immediate atrioventricular block after closure occurred in 38 （27.9%） patients. The percents of conduction blockade after operation and transient conduction were 9.8% and 5.9%, respectively in Group A, which were significantly lower than those in Group B （9.8% vs. 41.7% and 5.9% vs. 27.5%, P〈0.05）. Conclusion Transcatheter closure of VSD is associated with a high percentage of cardiac block. A seven day--electrocardiographic monitoring and preventive use of glucocorticoid are necessary, and the patients need to be followed up closely.