临时起搏在儿童缓慢心律失常中的应用分析
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摘要
目的探讨临时起搏治疗儿童缓慢心律失常的作用和效果。方法回顾性分析重庆医科大学附属儿童医院2007年6月至2018年5月收治的55例接受临时起搏治疗的缓慢心律失常患儿的临床资料,并对其临床特点及疗效进行总结和统计学分析。结果 55例缓慢心律失常包括心肌炎所致的严重房室传导阻滞(AVB)、窦性心动过缓或心搏停止29例,心肌病所致的Ⅲ°AVB或病窦综合征5例,先天性心脏病术后Ⅲ°AVB6例,先天性Ⅲ°AVB5例,Ⅲ°AVB围手术期临时起搏10例;其中39例可进行临时起搏前后阿-斯综合征发作频数比较(P=0.003),34例可进行射血分数及左室缩短率比较(P=0.000,P=0.001),26例可行左室舒张末期内径比较(P=0.001),差异均有统计学意义。经药物及临时起搏等治疗,18例临床治愈,36例好转,1例死亡,其中45%心律好转或恢复正常,10例围术期患儿均顺利度过手术麻醉期。Kruskal-Wallis H(K)检验结果显示,不同心血管基础疾病的临床及心律预后不完全相同(P=0.001,P=0.000);Mann-Whitney U检验提示心肌炎组预后较好(P=0.001,P=0.000)。结论临时起搏治疗有利于改善各种病因所致缓慢心律失常的临床症状,促进早期可逆的传导系统损伤恢复,降低Ⅲ°AVB围手术期风险,是一项安全、有效的预防和急救技术。
Objective To explore the effects and results of temporary cardiac pacing in children with bradyarrhythmia.Methods The clinical data of 55 children with bradyarrhythmia who received temporary cardiac pacing between June2007 and May 2018 in Children's Hospital of Chongqing Medical University were analyzed retrospectively. The clinical characteristics and curative effects were summarized and statistically analyzed. Results A total of 55 cases of bradyarrhythmia included 29 cases of severe atrioventricular block(AVB),sinus bradycardia or cardiac arrest caused by myocarditis,5 cases of Ⅲ°AVB or sick sinus syndrome caused by cardiomyopathy,6 cases of Ⅲ°AVB caused by congenital heart disease after surgery,5 cases of congenital Ⅲ°AVB,and 10 cases of perioperative temporary pacing Ⅲ°AVB.Among them,39 cases were compared in Adams-Stokes syndrome(P=0.003),34 cases were compared in ejection fraction and fractional shortening(P=0.000,P=0.001),and 26 patients were compared in left ventricular end diastolic diameter(P=0.001)before and after temporary pacing,and there were statistically differences. After treatment,18 cases were clinically cured,36 cases were improved,and 1 case died,among which 45% arrhythmia were improved or recovered,and 10 cases of perioperative children all passed through the anesthesia period. Kruskal-Wallis H(K)test showed that the clinical and arrhythmia prognosis of different basic cardiovascular diseases were not completely the same(P=0.001,P=0.000);Mann-Whitney U test indicated a better prognosis in the myocarditis group(P=0.001,P=0.000).Conclusion Temporary cardiac pacing can effectively relieve the clinical symptoms of severe bradyarrhythmia caused by various etiologies,promote the recovery of acute conduction system injury,and reduce Ⅲ°AVB perioperative risk.Temporary cardiac pacing is a safe and effective prevention and first-aid technique.
Objective To explore the effects and results of temporary cardiac pacing in children with bradyarrhythmia.Methods The clinical data of 55 children with bradyarrhythmia who received temporary cardiac pacing between June2007 and May 2018 in Children's Hospital of Chongqing Medical University were analyzed retrospectively. The clinical characteristics and curative effects were summarized and statistically analyzed. Results A total of 55 cases of bradyarrhythmia included 29 cases of severe atrioventricular block(AVB),sinus bradycardia or cardiac arrest caused by myocarditis,5 cases of Ⅲ°AVB or sick sinus syndrome caused by cardiomyopathy,6 cases of Ⅲ°AVB caused by congenital heart disease after surgery,5 cases of congenital Ⅲ°AVB,and 10 cases of perioperative temporary pacing Ⅲ°AVB.Among them,39 cases were compared in Adams-Stokes syndrome(P=0.003),34 cases were compared in ejection fraction and fractional shortening(P=0.000,P=0.001),and 26 patients were compared in left ventricular end diastolic diameter(P=0.001)before and after temporary pacing,and there were statistically differences. After treatment,18 cases were clinically cured,36 cases were improved,and 1 case died,among which 45% arrhythmia were improved or recovered,and 10 cases of perioperative children all passed through the anesthesia period. Kruskal-Wallis H(K)test showed that the clinical and arrhythmia prognosis of different basic cardiovascular diseases were not completely the same(P=0.001,P=0.000);Mann-Whitney U test indicated a better prognosis in the myocarditis group(P=0.001,P=0.000).Conclusion Temporary cardiac pacing can effectively relieve the clinical symptoms of severe bradyarrhythmia caused by various etiologies,promote the recovery of acute conduction system injury,and reduce Ⅲ°AVB perioperative risk.Temporary cardiac pacing is a safe and effective prevention and first-aid technique.
引文
[1]鲁开智,陶国才.临时心脏起搏器的应用[J].中华麻醉学杂志,2005,25(11):879-880.
[2]刘东,刘斌,贾鹏,等.临时心脏起搏治疗儿童缓慢性心律失常所致严重血流动力学紊乱3例报告[J].临床儿科杂志,2018,36(7):490-492.
[3]周爱卿,聂云章.小儿阿斯氏综合征药物与人工心脏起搏治疗的探讨[J].临床儿科杂志,1987,5(2):84-86.
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[5]Engin?,Ertugay S,Kemal HS,et al.New conduction defects and pacemaker implantation after heart transplantation[J].Turk J Thora Cardio Surg,2015,23(4):617-621.
[6]Canter CE,Simpson KP.Diagnosis and treatment of myocarditis in children in the current era[J].Circulation,2014,129(1):115-128.
[7]Bai Y,Xu XD,Li CY,et al.Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect:A single-center experience on 1046 cases[J].Heart Rhythm,2015,12(10):2132-2140.
[8]Holzer R,de Giovanni J,Walsh KP,et al.Transcatheter closure of perimembranous ventricular septal defects using the Amplatzer membranous VSD occluder:immediate and midterm results of an international registry[J].Catheter Cardiovasc Interv,2006,68(4):620-628.
[9]Butera G,Carminati M,Chessa M,et al.Transcatheter closure of perimembranous ventricular septal defects:early and longterm results[J].J Am Coll Cardiol,2007,50(12):1189-1195.
[10]Li P,Zhao XX,Zheng X,et al.Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder:Early and long-term results[J].Heart Vessels,2012,27(4):405-410.
[11]Bonatti V,Agnetti A,Squarcia U.Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease[J].Pediatr Med Chir,1998,20(3):181-186.
[12]Dung NM,Kneen R,Kiem N,et al.Treatment of severe diphtheritic myocarditis by temporary insertion of a cardiac pacemaker[J].Clin Infect Dis,2002,35(11):1425-1429.
[13]夏思良,张小兵,周建松.三度房室传导阻滞患者心脏起搏的临床分析[J].实用心电学杂志,2015,24(2):115-116.
[14]Gross GJ,Chiu CC,Hamilton RM,et al.Natural history of postoperative heart block in congenital heart disease:implications for pacing intervention[J].Heart Rhythm,2006,3(5):601-604.
[15]Aziz PF,Serwer GA,Bradley DJ,et al.Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease:duration alone predicts risk of late complete heart block[J].Pediatr Cardiol,2013,34(4):999-1005.
[16]Allen P,Robertson R,Trapp WG.Indications for treatment of complete atrioventricular dissociation[J].Can Med Assoc J,1964,91(10):547-552.
[17]Nowak B,Rosocha S,Zellerhoff C,et al.Is there a risk for interaction between mobile phones and single lead VDD pacemakers?[J].Pacing Clin Electrophysiol,2010,19(10):1447-1450.
[18]Nag K,Nagella AB,Kumar VRH,et al.Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome[J].Anesth Essays Res,2015,9(3):423-426.
[19]Baruteau AE,Pass RH,Thambo JB,et al.Congenital and childhood atrioventricular blocks:pathophysiology and contemporary management[J].Eur J Pediatr,2016,175(9):1235-1248.
[2]刘东,刘斌,贾鹏,等.临时心脏起搏治疗儿童缓慢性心律失常所致严重血流动力学紊乱3例报告[J].临床儿科杂志,2018,36(7):490-492.
[3]周爱卿,聂云章.小儿阿斯氏综合征药物与人工心脏起搏治疗的探讨[J].临床儿科杂志,1987,5(2):84-86.
[4]Members ATF,Brignole M,Auricchio A,et al.2013 ESCGuidelines on cardiac pacing and cardiac resynchronization therapy[J].Eur Heart J,2007,34(29):2281-2329.
[5]Engin?,Ertugay S,Kemal HS,et al.New conduction defects and pacemaker implantation after heart transplantation[J].Turk J Thora Cardio Surg,2015,23(4):617-621.
[6]Canter CE,Simpson KP.Diagnosis and treatment of myocarditis in children in the current era[J].Circulation,2014,129(1):115-128.
[7]Bai Y,Xu XD,Li CY,et al.Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect:A single-center experience on 1046 cases[J].Heart Rhythm,2015,12(10):2132-2140.
[8]Holzer R,de Giovanni J,Walsh KP,et al.Transcatheter closure of perimembranous ventricular septal defects using the Amplatzer membranous VSD occluder:immediate and midterm results of an international registry[J].Catheter Cardiovasc Interv,2006,68(4):620-628.
[9]Butera G,Carminati M,Chessa M,et al.Transcatheter closure of perimembranous ventricular septal defects:early and longterm results[J].J Am Coll Cardiol,2007,50(12):1189-1195.
[10]Li P,Zhao XX,Zheng X,et al.Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder:Early and long-term results[J].Heart Vessels,2012,27(4):405-410.
[11]Bonatti V,Agnetti A,Squarcia U.Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease[J].Pediatr Med Chir,1998,20(3):181-186.
[12]Dung NM,Kneen R,Kiem N,et al.Treatment of severe diphtheritic myocarditis by temporary insertion of a cardiac pacemaker[J].Clin Infect Dis,2002,35(11):1425-1429.
[13]夏思良,张小兵,周建松.三度房室传导阻滞患者心脏起搏的临床分析[J].实用心电学杂志,2015,24(2):115-116.
[14]Gross GJ,Chiu CC,Hamilton RM,et al.Natural history of postoperative heart block in congenital heart disease:implications for pacing intervention[J].Heart Rhythm,2006,3(5):601-604.
[15]Aziz PF,Serwer GA,Bradley DJ,et al.Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease:duration alone predicts risk of late complete heart block[J].Pediatr Cardiol,2013,34(4):999-1005.
[16]Allen P,Robertson R,Trapp WG.Indications for treatment of complete atrioventricular dissociation[J].Can Med Assoc J,1964,91(10):547-552.
[17]Nowak B,Rosocha S,Zellerhoff C,et al.Is there a risk for interaction between mobile phones and single lead VDD pacemakers?[J].Pacing Clin Electrophysiol,2010,19(10):1447-1450.
[18]Nag K,Nagella AB,Kumar VRH,et al.Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome[J].Anesth Essays Res,2015,9(3):423-426.
[19]Baruteau AE,Pass RH,Thambo JB,et al.Congenital and childhood atrioventricular blocks:pathophysiology and contemporary management[J].Eur J Pediatr,2016,175(9):1235-1248.