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目的探讨经导管封堵术治疗室间隔缺损前后动态心电图特点及临床意义。方法选择在广西壮族自治区人民医院成功施行经导管室间隔缺损介入封堵术(TCVSD)患者89例,分别于术前1d及术后1、30d描记24h动态心电图。结果①TCVSD术后1d总心搏、室上性、室性早搏、(非)阵发性室速发生率明显高于术前1d(P<0.05);TCVSD术后30d各种心律失常发生率与术前1d对比差异无统计学意义(P>0.05);②TCVSD前1d与术后7d内传导阻滞发生率差异有统计学意义(P<0.01),术后30d随访传导阻滞发生率与术前差异无统计学意义(P>0.05)。③QT间期、QTd术前1d与术后1、30d比较逐渐延长(P<0.05);电轴术后1d与术前1d比较左偏幅度增大(P<0.01);术后30d与术前1d比较无明显变化(P>0.05)。结论TCVSD术后多种因素可影响心律失常的发生类型及发生率,但这种改变多为暂时性可恢复正常,故经导管封堵术治疗室间隔缺损是一种安全有效的方法。近期疗效肯定,中远期疗效尚需进一步观察。
Objective To investigate the characteristics and clinical significance of ambulatory electrocardiogram before and after transcatheter closure of ventricular septal defect. Methods Eighty-nine patients with successful transcatheter closure of ventricular septal defect (TCVSD) were enrolled in the People’s Hospital of Guangxi Zhuang Autonomous Region. The electrocardiogram was recorded at 1 day and 1 day and 30 days after operation respectively. Results ① The incidence of paroxysmal ventricular tachycardia, supraventricular premature beats, premature ventricular contractions and (non) paroxysmal ventricular tachycardia was significantly higher than that before preoperative 1 day after TCVSD (P <0.05); the incidence of arrhythmia (P> 0.05). ② The incidence of conduction block was significantly higher on the first day before the TCVSD and on the 7th day after operation (P <0.01). The incidence of follow-up block and the rate of postoperative follow-up Before the difference was not statistically significant (P> 0.05). QT interval, QTd preoperative 1d and 1, 30d postoperatively gradually extended (P <0.05); 1d after the electrical axis compared with the preoperative 1d left amplitude amplitude increased (P <0.01); 30d after surgery and preoperative 1d no significant change (P> 0.05). Conclusions After the operation of TCVSD, many factors may affect the type and incidence of arrhythmia, but most of the changes are transient and can be recovered to normal. Therefore, transcatheter closure of ventricular septal defect is a safe and effective method. The recent efficacy is sure, the long-term efficacy needs further observation.