CAJ | 학술논문

目的了解进口和国产膜部窜间隔缺损(VSD)封堵器封堵小儿先天性膜周部VSD术后心律失常和残余分流的改变和差异.方法 2003年1月至2008年6月在本院成功封堵的膜周部VSD患儿396例,应用进口膜部VSD封堵器和装置封堵膜周部VSD组186例;国产膜部VSD封堵器和装置封堵膜周部VSD组210例.术中严密监测心电图(ECG)改变,术后常规持续心电监测3～7 d,必要时1～2周.观察ECG各波段的变化,分析各组心律失常和残余分流的发生率及评价重度心律失常病例的临床转归.结果膜部瘤样VSD较其他类型膜周部VSD更容易发生心律失常和残余分流(48.8%比29.1%,X~2=5.21,P<0.05;12.5%比0.9%,X~2=23.31,P<0.01);进口封堵器封堵膜部瘤样VSD均较封堵其他类型膜周部VSD易于导致心律失常和残余分流(68.2%比28.0%,X~2=14.18,P<0.01;36.4%比1.2%,X~2=40.44.P<0.01);封堵膜部瘤样VSD进口封堵器较国产者更易导致心律失常和残余分流(68.2%比41.4%,X~2=4.60,P<0.01;36.4%比3.4%,X~2=15.60,P<0.01),而封堵其他类型膜周部VSD心律失常和残余分流发生率差异并无统计学意义.国产封堵器封堵膜部瘤样VSD和其他膜周部VSD导致心律失常和残余分流则无差异.进口和国产2组各出现3例Ⅲ度房窜传导阻滞(Ⅲ度AVB)或间歇Ⅲ度AVB.出现Ⅲ度AVB的6例中除1例应用进口封堵器者为膜周部VSD,其他5例均为膜部瘤样VSD.结论进121和国产封堵器封堵膜周部VSD均可导致Ⅲ度AVB等严重心律失常发生.但国产封堵器封堵膜部瘤样VSD发生心律失常和残余分流较进口封堵器少.术中和术后应密切观察ECG的改变.
목적 료해진구화국산막부찬간격결손(VSD)봉도기봉도소인선천성막주부VSD술후심률실상화잔여분류적개변화차이.방법 2003년1월지2008년6월재본원성공봉도적막주부VSD환인396례,응용진구막부VSD봉도기화장치봉도막주부VSD조186례;국산막부VSD봉도기화장치봉도막주부VSD조210례.술중엄밀감측심전도(ECG)개변,술후상규지속심전감측3～7 d,필요시1～2주.관찰ECG각파단적변화,분석각조심률실상화잔여분류적발생솔급평개중도심률실상병례적림상전귀.결과 막부류양VSD교기타류형막주부VSD경용역발생심률실상화잔여분류(48.8%비29.1%,X~2=5.21,P<0.05;12.5%비0.9%,X~2=23.31,P<0.01);진구봉도기봉도막부류양VSD균교봉도기타류형막주부VSD역우도치심률실상화잔여분류(68.2%비28.0%,X~2=14.18,P<0.01;36.4%비1.2%,X~2=40.44.P<0.01);봉도막부류양VSD진구봉도기교국산자경역도치심률실상화잔여분류(68.2%비41.4%,X~2=4.60,P<0.01;36.4%비3.4%,X~2=15.60,P<0.01),이봉도기타류형막주부VSD심률실상화잔여분류발생솔차이병무통계학의의.국산봉도기봉도막부류양VSD화기타막주부VSD도치심률실상화잔여분류칙무차이.진구화국산2조각출현3례Ⅲ도방찬전도조체(Ⅲ도AVB)혹간헐Ⅲ도AVB.출현Ⅲ도AVB적6례중제1례응용진구봉도기자위막주부VSD,기타5례균위막부류양VSD.결론 진121화국산봉도기봉도막주부VSD균가도치Ⅲ도AVB등엄중심률실상발생.단국산봉도기봉도막부류양VSD발생심률실상화잔여분류교진구봉도기소.술중화술후응밀절관찰ECG적개변.
Objective To investigate the changes and differences of arrhythmia and residual shunt arising from interventional treatment in children with congenital perimembranous ventricular septal defect (PMVSD) using homemade and imported occluder devices. Methods Between January 2003 and June 2008, 396 PMVSD children were successfully treated with occluder devices in our hospital, comprising 186 with imported products and 210 with homemade ones. Close observation on ECG was made during the procedures and was sustained as a routine until 3 to 7 days after treatment, or 1 to 2 weeks if indicated, to identify the changes in each ECG lead. Incidences of arrhythmia and residual shunt in both groups were recorded and clinical outcome of children with severe arrhythmia was evaluated. Results Arrhythmia and residual shunt were observed more in bulging-type than in other types of PMVSD (48.8% vs 29.1%, X~2=5.21, P<0.05; 12.5% vs 0.9%, X~2=23.31, P<0.01), as were more likely to occur after use of imported devices (68.2% vs 28.0%, X~2=14.18, P<0.01; 36.4% vs 1.2%, X~2=40.44, P<0.01). Imported devices resulted in more arrhythmia and residual shunt than did homemade products after treatment of bulging-type PMVSD (68.2% vs 41.4%, X~2=4.60, P<0.01 ; 36.4% vs 3.4%, X~2=15.60, P<0.01), but such an observation was not significant when the both were used for other types of PMVSD. Homemade devices were not found to induce more cases of arrhythmia and residual shunt than other types of PMVSD. The complete or recurrent third-degree atrioventricular block ( Ⅲ°AVB) occurred in 3 cases of each group using homemade or imported devices. Among them, one was with usual PMVSD and the other 5 were with bulging- type PMVSD. Conclusions While arrhythmia and residual shunt can be observed with treatment of PMVSD using either homemade or imported occluder devices, homemade products may result in lower incidence in bulging-type VSD than do imported devices. Close monitoring of ECG during and after treatment should be mandatory.