【作者】 莫剑梅；

【导师】 刘唐威；

【作者基本信息】 广西医科大学 ， 内科心血管病学， 2006， 硕士

【摘要】 目的观察先天性心脏病(先心病)患者经皮导管封堵术后心电及心室形态、功能的变化,探讨封堵术后近期心电及心室重构的影响。方法成功施行经皮导管封堵术的先心病患者111例,其中ASD47例,VSD44例,PDA20例。通过TTE、ECG及动态心电图,观察先心病患者经导管封堵术前、术后心电参数、心室形态和功能超声指标。结果1、经皮导管封堵术后心电变化:(1)与ASD封堵术前比较,术后3天、1个月、3个月及6个月的RBBB发生率明显减少(P均﹤0.05),但患者术后3天、1个月、3个月及6个月之间的RBBB发生率无明显差别(P均﹥0.05)。与ASD封堵术前比较,术后1个月、3个月及6个月的电轴右偏发生率明显减少(P均﹤0.01)。(2)与VSD封堵术前比较,术后3天的RBBB/LBBB发生率明显增多(P均﹤0.05),但患者术后3个月及6个月的RBBB/LBBB发生率又逐渐减少至正常(P均﹤0.05)。(3)与PDA封堵术前比较,患者术后3个月、6个月的LVH发生率均明显下降(P均﹤0.01),术后1个月、3个月、6个月的电轴左偏发生率均明显下降(P均﹤0.01)。2、经皮导管封堵术后动态心电图参数改变:(1)ASD封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。(2)VSD封堵术后患者平均心率、室上性早搏、室性早搏与术前相比无明显差别(P均﹥0.05),但术后2天内阵发性室性心动过速发生率明显多于术前(P均﹤0.01)。(3)PDA封堵术后患者平均心率、室上性早搏、室性早搏及房性心律失常发生率与术前相比无明显差别(P均﹥0.05)。3、经皮导管封堵术后心室形态及功能改变:(1)、与ASD封堵术前相比较,ASD患者术后1个月、3个月及6个月的LVED、LVEDD、LVSD及LVESD均明显增加(P均﹤0.05),RVED、RVOTD明显缩小(P均﹤0.01);但患者术后1个月、3个月及6个月之间LVED、LVEDD、LVSD、更多还原

【Abstract】 Objectives To investigate the changes of electrophysiology and ventricular form, function after transcatheter device closure of ASD, VSD and PDA.And evaluate the effect on the electrophysiology and ventricular-remodeling after procedure in patients with congenital heart disease.Methods 111 patients underwent procedure successfuly, 47 was ASD,44 was VSD and 20 was PDA. All patients were performed 12 lead- synchronous surface electrocardiogram, Ambulatory Holter monitoring and TTE study, analysised the parameters of electrocardic and the indexs of ventricular form and function pre- and after- procedure.Results 1 The changes of electrophysiology after procedure. (1) In patients with ASD, compared with the pre-procedure, 3 days,1,3 and 6 months later, the incidence rate of RBBB decreased significantly(P﹤0.05); But the incidence rate of RBBB in all patients with ASD had no significance change between the 3 days, 1,3 and 6 months(P﹥0.05). Compared to pre-procedure,the electrical axis toward the right incidence rate decreased significantly in 1,3 and 6 months after the procedure,P<0.01.(2) Of the patients with VSD, compared with the pre-procedure, 3 days later, the incidence rate of RBBB/LBBB increased significantly(P﹤0.05). But 3 and 6 months later, the incidence rate of RBBB/LBBB decreased significantly(P﹤0.05).(3) Of the patients with PDA, compared with the pre-procedure,the incidence rate of LVH decreased significantly in the 3 and 6 months after the procedure(P﹤0.01); The electrical axis toward the left incidence rate decreased significantly in the 3 and 6 months after the procedure, P<0.01. 2 The changes of the parameters of the更多还原