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目的探讨经导管介入治疗小儿膜周部室间隔缺损(VSD)发生心律失常的特点及其处理。方法南京医科大学附属南京市儿童医院心血管科2002-09—2006-03经导管介入治疗VSD 108例,其中发生心律失常的患儿共计22例,动态观察22例患儿封堵术前心电图(ECG)以及封堵后发生心律失常ECG的变化及其处理。结果22例中2例在术中反复出现Ⅲ度房室传导阻滞(AVB),被迫中断;8例患儿术后3d内出现加速性交界性或室性自主心律伴干扰性房室分离,经治疗后均转为窦性心律,其中2例患儿1个月后才恢复窦性心律;6例患儿术后3d内出现束支传导阻滞,经治疗后3例恢复正常,3例仍存在不同程度的束支传导阻滞;5例患儿术后3d内发生高度AVB,其中3例经使用激素、维生素C、果糖及静滴异丙肾上腺素和临时起搏器治疗后,均在1周内恢复窦性心律,另2例患儿经治疗后,1例于10d后转为窦性心律,1例于术后2年时仍有完全性右束支阻滞+左前分支阻滞;1例患儿术后1个月随访发现完全性右束支阻滞。结论术后早期出现的心律失常多能恢复,而后期出现的传导阻滞多为器质性损伤。对已经出现传导阻滞的患儿关键是早期治疗,适当延长术后观察时间。
Objective To investigate the characteristics and treatment of arrhythmia caused by transcatheter closure of perimembranous ventricular septal defect (VSD) in children. Methods Nanjing Cardiovascular Hospital Affiliated Nanjing Children’s Hospital 2002-09-2006-03 Transcatheter interventional treatment of 108 cases of VSD, including a total of 22 cases of arrhythmia in children, dynamic observation of 22 cases of children with preoperative closure of the ECG ( ECG) and ECG changes after arrhythmia and its treatment. Results Of the 22 cases, 2 cases had Ⅲ degree atrioventricular block (AVB) recurrence during operation, which was interrupted. 8 cases had accelerated junctional or ventricular tachycardia with disturbed atrioventricular separation , After treatment were converted to sinus rhythm, of which 2 cases of children after 1 month to restore sinus rhythm; 6 cases of children within 3 days after the emergence of bundle branch block, after treatment, 3 cases returned to normal, 3 There were still some degree of bundle branch block. Five patients developed high AVB within 3 days after operation. Three of them were treated with hormone, vitamin C, fructose, intravenous isoproterenol and temporary pacemaker, Sinus rhythm were recovered in 1 week, and in the other 2 cases, 1 case was converted to sinus rhythm after 10 days and 1 case still had complete right bundle branch block + left anterior branch 2 years after operation 1 case of children with complete right bundle branch block at 1 month follow-up. Conclusions Early arrhythmia can be recovered early after operation, and late conduction block is mostly organic injury. For children who have had conduction block is the key early treatment, appropriate to extend postoperative observation time.