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改良Fontan术后心律失常及危险因素 |
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张南滨 汪曾炜 费诚鉴 张仁福 朱洪玉
【摘要】 目的 分析改良Fontan手术后心律失常及其危险因素,以期降低术后心律失常的发生率。方法 对1984～1996年间111例患者术后心律失常发生类型及发生因素进行分析。结果 房性心动过速(房速)发生率最高,占心律失常的43.9%；非阵发性交界性心动过速次之,占28.8%。房速者术后中心静脉压显著升高,右房与肺动脉连接者术后房速及非阵发性交界性心动过速的发生率均显著高于全腔静脉与肺动脉连接者。结论 术后中心静脉压明显升高及右房与肺动脉连接术式是影响术后心率失常的主要危险因素。
【关键词】 心律失常 危险因素 心脏外科手术
Arrhythmias and their risk factors after the Fontan operation
Zhang Nanbin, Wang Zengwei, Fei Chengjian, et al. Department of Cardiovascular Surgery, Shenyang General Hospital PLA, Shenyang 110015
【Abstract】 Objective To identify the risk factors resulting in arrhythmias after modified Fontan operation so as to decrease the incidence of arrhythmias.Methods The types and risk factors of arrhythmias were analysed in 111 cases who underwent modified Fontan operation from 1984 to 1966. Results The incidence of atrial tachycardia was the highest (43.9%) and that of nonparoxysmal junctional tachycardia was the next (28.8%). The central venous pressure after operation was significantly higher in patients with atrial tachycardia than that in the patients without atrial tachycardia (20.3cmH2O±3.18cmH2O vs 16.7 cmH2O±2.83cmH2O, P<0.01). The patients undergoing a direct atriopulmonary connection yielded a higher incidence of atrial tachycardia and nonparoxysmal junctional tachycardia than those undergoing a cavopulmonary connection.Conclusion The findings suggest that the high central venous pressure and the direct atriopulmonary connection were both the main risk factors leading to arrhythmias after modified Fontan operation.
【Key words】 arrhythmia risk factors heart surgery
近年来,改良Fontan手术已广泛用于治疗各种复杂先天性心脏畸形,由于患者缺少有效的右心室泵功能,术后并发症较多,心律失常是手术后早期严重的并发症之一,尤其房性心动过速(房速)常与术后血液动力学不稳定有关,甚至导致死亡。本研究对我科1984～1996年间111例改良Fontan术后患者心律失常发生情况及危险因素作一分析。
资料与方法
本组111例中，男78例、女33例,年龄2～34岁,体重12～69公斤。诊断包括：单心室56例、三尖瓣闭锁28例、右室双出口11例、二尖瓣闭锁7例、完全性大动脉转位5例及校正性大动脉转位、孤立性右室发育不全、Ebstein畸[1] [2] 下一页
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