经导管膜周部室间隔缺损封堵术患儿术后早期心律失常的发生因素

Arrhythmia Related Factors at Early Stage in Children after Transcatheter Occlusion of Perimembranous Ventricular Septal Defects

目的回顾性分析膜周部室间隔缺损(PMVSD)患儿经导管封堵术后早期心律失常的发生因素,以预防及尽早干预心律失常。方法选择2004年2月-2007年2月在山东大学附属省立医院小儿心脏科行经导管PMVSD封堵术的患儿80例。男38例,女42例;年龄2岁5个月～18岁,平均7.9岁。所有患儿分别于术前1d及术后1d、3d、5d行心电图检查。结果 1.PMVSD患儿80例中,77例封堵成功,封堵成功率为96.25%。2.行PMVSD封堵术患儿77例中,发生心律失常35例(45.45%)。其中房室传导阻滞9例(11.69%),束支传导阻滞28例(36.36%),非阵发性交界性心动过速4例和非阵发性室性心动过速3例(9.09%),发生心律失常的35例中9例发生2种以上心律失常(11.69%)。3.PMSVD直径<8mm的患儿心律失常发生率较≥8mm者显著减低(36.73%vs64.29%,P<0.05);无膜部瘤形成的PMVSD患儿心律失常发生率显著高于有膜部瘤形成的患儿(67.50%vs24.32%,P<0.05);封堵器型号<8mm的患儿心律失常发生率较封堵器型号≥8mm者显著减低(37.74%vs63.64%,P<0.05)。4.股动脉、股静脉轨道建立时间短于60min的患儿心律失常发生率显著低于时间超过60min者(30.30%vs59.09%,P<0.05)。结论严格选择PMVSD患儿介入治疗适应证、缩短手术操作时间及规范选择封堵器的类型与型号,有利于减少PMVSD介入封堵术心律失常的发生。

Objective To analyze retrospectively the arrhythmia related factors at early stage in children after transeatheter occlusion of perimembranous ventricular septal defect（PMVSD） ,in order to prevent and interfere with arrhythmia as early as possible. Methods From Feb. 2004 to Feb. 2007,80 chihtren（38 male,42 female）were selected to undergo transcatheter occlusion of PMVSD in Provincial Hospital Affiliated to Shandong University. The mean age of children was 7.9 years old（ 1.4 - 18.0 years old）. Electrocardiogram examination was determined in 1 day before procedure,and 1 day,3 days and 5 days procedure. Results 1. Among 80 children with PMVSD,77 children performed transcatheter ncelusion successfully （96.25%）. 2. Totally 35 children with PMVSD occlusion suffered from different types of arrhythmia（45.45% ） ,9 children had atrioventricular block（ 11.69% ） ,28 children had bandle branch block （36.36%） ,4 children had nonparoxysm junctional tachycardia,3 chihlren occurred nonparoxysm wmtricular tachycardia（9.09% ）. Among 35 children,9 children occurred more than 2 types of arrhythmia（11.69% ）. 3. The incidence of an-hythmia in children whose PMVSD diameter was less than 8 mm （36.73%） was lower than that in children whose PMVSD diameter was more than 8 mm （64.29%） （P 〈0. 05 ）. The incidence of arrhythmia in children with PMVSD membranous aneurysm formulation （24.32%） were much lower than that in children without PMVSD membranous aneurysm fornmlation （67.50%） （ P 〈 0.05 ）. The incidence of arrhythmia in children whose type of PMVSD nccluder was less than 8 mm （37.74%） was lower than that in children whose type of PMVSD oeclader was omre than 8 mm（63.64% ）（ P 〈0.05）. 4. The incidence of atwhythmia in children whose time of setting up of femoral artery to femoral vein track less than 60 minutes （30.30%） were lower than that in ehildren whose total procedure time more than 60 minutes（59.09% ） （ P 〈 0.05）. Conclusions It may be benefit for decreasing incidence of arrhythmia if the chihtren following the standard indications strictly,shorten procedure time and choose the suitable type of PMVSD oeelader were selected for the patients with PMVSD occlusion.