间隔缺损术后Ⅲ度房室传导阻滞发生的临床探讨

目的探讨间隔缺损术后发生Ⅲ度房室传导阻滞(CAVB)的原因、防治措施与转归。方法对178例间隔缺损患儿术后进行回顾性分析,其中房缺58例,室缺120例,经体外循环下心脏直视术后11例发生CAVB,采用起搏器加激素为主的治疗方案。对178例中11例间隔缺损术后发生CAVB的缺损部位、手术方式、发生时间、持续时间和转归进行分析。结果178例间隔缺损术后发生CAVB 11例,经治疗7例患儿恢复正常心律出院,1例患儿持续房室传导阻滞(AVB),2例为间歇Ⅲ度AVB,1例患儿猝死。发现术后房室传导阻滞发生与缺损部位、手术方式以及阻断主动脉时间、心肌局部组织水肿等有关。结论间隔缺损的部位及手术路径是导致心脏直视术后发生AVB的主要影响因素,故熟悉传导束与缺损部位的解剖关系,改良手术路径是防止术后发生AVB的关键。多数AVB能恢复正常心律,少数发展为持续AVB,持续时间在1个月以上者预后差,应考虑安装永久起搏器。

Clinical research of post-operative Ⅲ°atrioventricular block in septal defects

Objective To explore the prognosis and protective ways of post-operative complete atrioventricular block(CAVB)in septal defects.Methods Retrospective data of 178 patients after surgical closure of septal defects were studied,of which 58 were atrial septal defects,120 were ventricular septal defects.In the 178 patients,11 cases of CAVB caused by open heart operation with extravorpored circulation were treated mainly with pacemaker and adrenocortical hormone.The defect sites,operantion ways,happening time of CAVB and its duration,prognosis were analyzed in the 11 patients.Results Of the 11 postoperative CAVB patients,7 recovered to normal heart rhythm,1 kept sustained AVB,1 suddenly died.Postoperative CAVB was mainly relative to defect sites,operation ways,duration of bypass,regional myocardial edema.Conclusion Defect sites and operation ways are key factors to AVB after open heart extracorporeal operation.So it is important to master the relation between conduct bundle anatomy and defect sites and changing operation ways is the key to avoiding AVB.Most AVB is able to return to nomal,a few may progress to sustained AVB.Patients with CAVB lasting more than 1 month have poor prognosis and permanent pace makers should be recommended.