完全性房室传导阻滞的临床特点及治疗效果

Clinical Feature and Therapeutic Effect of Complete Atrioventricular Block in Infants

目的探讨小儿完全性房室传导阻滞(CAVB)的病因、临床表现、治疗方法和预后。方法回顾性总结本院近5 a诊断为CAVB的53例患儿的临床资料,按病因分为先天性CAVB组和获得性CAVB组。根据其临床症状,参照起搏器安装指南,采用不同的治疗方案,并随访观察其预后。结果确诊为先天性CAVB者11例,其中因阿斯发作就诊者5例,其余均为体检时发现心律失常而确诊。获得性CAVB 42例中先天性心脏病术后32例,最常见为VSD、右心室双出口和大动脉转位;重症心肌炎患者8例,就诊时分别表现为胸闷、胸痛、面色苍白2例,呕吐、腹泻4例,咳嗽、流涕2例;另2例为高钾血症引发CAVB。先天性CAVB患儿中,6例安装永久起搏器,随访4例,其中1例随访4 a出现心功能不全。获得性CAVB患儿中18例安装起搏器,其中先天性心脏病术后17例,重症心肌炎患儿1例。随访12例,其中1例右心室双出口患儿安装心外膜起搏器,随访5 a时因电极移位、起搏无效猝死。结论部分先天性CAVB患儿需安装永久起搏器;而获得性CAVB以治疗原发病为主,治疗无效而符合起搏器安装指征者需安装起搏器,起搏器是治疗房室传导阻滞安全、有效的方法,随访需关注起搏器并发症。

Objective To explore the pathogenesis, clinical symptom, therapy and prognosis of complete atrioventricular block （CAVB） in children. Methods The clinical data of 53 children with CAVB who were diagnosed in the past 5 years were reviewed, the patients were divided into congenital CAVB group and acquired CAVB group, and they were treated with different protocol based on clinical symptoms, consulted on the guideline for implanting pacemaker（PM） respectively. The prognosis was recorded. Results Eleven patients were in congenital CAVB group,5 cases of them had Adams - Stokes＇s syndrome as first onset and the others were diagnosed as arrhythmia in physical examina- tion. Forty - two patients were in acquired CAVB group, 32 cases of them were postoperative of congenital heart disease, most disease were ventricular septal defect, double outlet of right ventricle and corrected transposition of great arteries. Eight patients were diagnosed as severe myocarditis ,2 cases of them had dyspnea and chest pain,4 cases had vomiting and diarrhea,and 2 cases had cough and nasal discharge. Six patients with congenital CAVB implanted permanent PM ,4 cases were in following up. One of patients implanted PM had heart failure 4 years later. Eighteen patients with acquired CAVB implanted PM, 1 case of double outlet of right ventricle died of pacing failure 5 years after procedure. Conclusions Some of children with congenital CAVB should be implanted permanent PM ; however, children with acquired CAVB should be emphasized to treat primary disease and few of them should be considered to implant PM, even though that was a safe and effective therapy to CAVB, the complication of PM should be considered when following up.