心脏直视手术后一过性房室传导阻滞原因分析

ANALYSIS OF THE RISK FACTORS OFTRANSIENT ATRIOVENTRICULAR BLOCK AFTER OPEN HEART SURGERY

为探讨心脏手术后一过性房室传导阻滞（ＡＶＢ）的原因，应用统计学方法，对８７２例患者中的１４项可能成为心脏直视手术后一过性ＡＶＢ原因的指标进行χ２检验、ｔ检验及ｌｏｇｉｓｔｉｃ回归分析。在先天性心脏病中，术前心功能、体外循环时间、术中最低体温、术后血Ｋ＋、ｐＨ、ＰａＣＯ２、ＰａＯ２及ＢＥ在发生ＡＶＢ者与未发生ＡＶＢ者之间差异有显著性（Ｐ≤０．０５），２岁以下者ＡＶＢ发生率较２岁以上者明显增高（Ｐ＜０．０５）；在后天性心脏病中，术前心功能、术后血ｐＨ、ＰａＣＯ２、ＰａＯ２及ＢＥ在发生ＡＶＢ者与未发生ＡＶＢ者间差异有显著性（Ｐ＜０．０５）。术前存在传导异常者，术后ＡＶＢ发生率高于术前无传导异常者（Ｐ＜０．０１）。提示心脏直视手术后一过性ＡＶＢ的发生与病情、心功能、手术年龄、外科损伤、体外循环及主动脉阻断时间、术中低温、术前传导状态及术后代谢紊乱有关。

To research the causes of transient AVB developed after open heart surgery, 14 possibly risk factors in the 872 patients accepted open heart surgery were analyzed by 2 test, t test and logistic regression analysis . In congenital heart diseases(CHD), preoperative cardiac function, duration of CPB and ACC, the lowest body temperature during operation, the blood K+,pH,PaCO2,PaO2 and BE were significantly different between the patients developed AVB and the patients undeveloped AVB (P0.05). The incidence of AVB in the ages under two years was much higher than that of the ages over two years (P<0.05). In acquired heart diseases (AHD), blood pH,PaCO2,PaO2 and BE were also significantly different between the patients developed AVB and the patients undeveloped AVB (P<0.05). The incidence of AVB was higher in patients with conduction disturbance before operation than those without conduction disturbance(P<0.01). The results indicated that the nine factors were correlated with the development of transient AVB after open heart surgery. Those are types of diseases, cardiac function, age, surgical trauma, long duration of CPB and ACC, low temperature during operation, conduction disturbance before operation and metabolic disturbance after operation.