小儿先天性心脏病介入治疗前后心律失常及心率变异性变化与术后心功能相关性分析

目的:分析小儿先天性心脏病（CHD）介入治疗前后心律失常、心率变异性变化及其与术后心功能的相关性。方法:选取行介入封堵术治疗的79例CHD患儿作为研究对象，根据患儿病情分为房间隔缺损（ASD）组（n=26）、室间隔缺损（VSD）组（n=39）、动脉导管未闭（PDA）组（n=14）。比较3组患儿介入治疗前后心律失常及心率变异性（HRV）变化情况，并分析术后心功能与HRV时域指标相关性。结果:79例患儿中术前共有28例（35.44%）检出40例次（50.63%）不同类型心律失常，其中以房性期前收缩（<30次/小时）、室性期前收缩（Lown's 1级）、不完全右束支阻滞为主，分别占32.50%、22.50%和12.50%；术后共有17例（21.52%）检出54例次（68.35%）不同类型心律失常，较术前升高（P<0.05），其中VSD组检出率最高，为53.70%（29/54），较术前升高（P<0.05）；PDA组患儿术后24 h内每5 min节段R-R间期均值标准差（SDANN）高于术前（P<0.05）；ASD、VSD组患儿术后24 h内R-R间期标准差（SDNN）、SDANN、正常R-R间期均值（R-R）均高于术前（P<0.05～P<0.01）；Killip心功能分级为Ⅰ级、Ⅱ级患儿R-R、SDNN、SDANN均显著高于Ⅲ级和Ⅳ级患儿（P<0.01）；Ⅰ级患儿24 h内每5 min节段R-R间期标准差均值（ASDNN）高于Ⅲ级和Ⅳ级患儿（P<0.05）；Ⅰ级、Ⅱ级患儿相邻正常RR间期差值的均方根（rMSSD）均高于Ⅳ级患儿（P<0.05）；HRV时域指标与心功能分级呈显著正相关关系（P<0.05）。结论:CHD患儿介入治疗后会出现新发心律失常，治疗后HRV出现不同升高，且与患儿心功能相关。

Analysis of the correlation between arrhythmia and heart rate variability,and postoperative cardiac function in children with congenital heart disease before and after intervention therapy

Objective: To investigate the correlations between arrhythmia and heart rate variability(HRV),and postoperative cardiac function in children with congenital heart disease(CHD) before and after intervention therapy.Methods: Seventy-nine CHD children treated with interventional occlusion were divided into the atrial septal defect group(ASD group,26 cases),ventricular septal defect(VSD group,39 cases),and patent ductus arteriosus(PDA group,14 cases) according to the disease.The changes of arrhythmia and HRV between three groups were compared before and after interventional therapy,and the correlation between postoperative cardiac function and HRV time domain indexes was analyzed.Results: Among 79 cases,the different types of arrhythmia of 40 cases(50.63%) in 28 patients(35.44%) were detected,and the ratios of atrial premature beat(<30 times/h),room premature beat(Lown's level 1) and incomplete right bundle branch block were 32.50%,22.5% and 12.50%,respectively.After operation,54 cases(68.35%) in 17 patients(21.52%) with different types arrhythmia were detected,which increased compared with before operation(P<0.05).The detection rate of different types arrhythmia in VSD group was the highest(53.70%),which was significantly higher than that before operation(P<0.05).The SDANN in PDA group during the postoperative 24 h was significantly higher than that with before operation(P<0.05).The SDANN,R-R and SDNN in ASD and VSD group during the postoperative 24 h were significantly higher than those before operation(P<0.05 to P<0.01).The levels of SDANN,R-R and SDNN in children with grade Ⅰ and Ⅱ Killip cardiac function were significantly higher than those in children with grade Ⅲ and Ⅳ Killip cardiac function(P<0.01).The level of ASDNN in children with grade Ⅰ Killip cardiac function was significantly higher than that in children with grade Ⅲ and Ⅳ Killip cardiac function during the postoperative 24 h(P<0.05).The rMSSD in children with grade Ⅰ and Ⅱ Killip cardiac function were significantly higher than that in children with grade Ⅳ Killip cardiac function during(P<0.05).HRV time domain index was significantly positively correlated with cardiac function classification(P<0.05).Conclusions: After intervention treatment,the new arrhythmia and HRV elevation in CHD children may occur,which is related to the heart function of patients.