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目的通过介入手术治疗小儿先天性心脏病,总结各种心律失常发生的规律,分析高危心律失常易发生的高危因素。方法进行先天性心脏病介入治疗的患者500例,观察患者术前一般情况,如年龄、性别、身高、体重等,同时症状体征、既往病史,心功能分级,心电图相关指标超声心动图及心律失常情况,必要时可行Holter检查。术后3 d、3个月、6个月复查心电图、心脏彩超相关指标。结果术前心律失常发生率7%,术后27.6%,术后3个月为4.8%,术后随访至6个月,所有新发心律失常均恢复,总恢复率为100%。出院前房性心律失常组与未发生房性心律失常组间比较,结果显示年龄、心律失常史、左房舒张末期内径、小儿先天性心脏病类型和胸片心胸比率比较,差异有统计学意义(P<0.05);回归分析采用逐步回归渐近方对单因素分析结果中有统计学意义、的各临床指标进行分析,结果可能导致治疗后房性心律失常的独立危险因素包括年龄、术前心律失常史(OR值=1.340,3.030,P<0.01)。结论介入封堵术治疗小儿先天性心脏病操作简单,手术时间短,患者痛苦小,恢复快,不需体外循环及输血,优于外科手术治疗;介入治疗组患者出院前房性心律失常发生率低;年龄偏大、术前合并心律失常史为小儿先天性心脏病治疗后房性心律失常的危险因素,且术前合并心律失常史危险度高于年龄。
Objective By interventional treatment of children with congenital heart disease, summarize the occurrence of various arrhythmias, analysis of high-risk arrhythmias prone to risk factors. Methods 500 cases of patients with congenital heart disease interventional treatment were observed preoperative general conditions such as age, gender, height, weight, etc., while symptoms and signs, past medical history, cardiac function classification, ECG-related echocardiography and cardiac arrhythmia Holter check if possible. Postoperative 3 d, 3 months, 6 months review of ECG, cardiac ultrasound related indicators. Results The incidence of preoperative arrhythmia was 7%, postoperative 27.6%, postoperative 3 months 4.8%, postoperative follow - up to 6 months, all new arrhythmias were recovered, the total recovery rate was 100%. Atrial arrhythmia before discharge and without atrial arrhythmia group comparison, the results showed that age, history of arrhythmia, left atrial end-diastolic diameter, congenital heart disease in children and chest X-ray ratio, the difference was statistically significant (P <0.05). Regression analysis using stepwise regression asymptotic analysis of the single factor analysis of the statistical significance of the clinical indicators were analyzed, the results may lead to treatment of atrial arrhythmia independent risk factors including age, preoperative Arrhythmia history (OR = 1.340, 3.030, P <0.01). Conclusion The interventional closure therapy for children with congenital heart disease is simple, the operation time is short, the patient is less painful, faster recovery, without cardiopulmonary bypass and blood transfusion, better than surgical treatment; patients in the intervention group were discharged before the occurrence of atrial arrhythmia Low; older, preoperative arrhythmia history of children with congenital heart disease after atrial arrhythmia risk factors, and preoperative risk of arrhythmia history than age.