Page 54 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第2期
·200 · Journal of Nanjing Medical University（Natural Sciences） 2022年2月

·临床医学·

介入治疗膜周部室间隔缺损术后传导阻滞的危险因素再分析

邢子琳 ，张 浩 ，孙 伟 ，张海锋 ，雍永宏 ，杨 荣 ，盛燕辉 ，孔祥清 1，2
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南京医科大学第一附属医院心血管内科，江苏 南京 210029；南京医科大学附属苏州医院心血管病中心，南京医科大学
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姑苏学院，江苏 苏州 215008
［摘 要］ 目的：在前期总结的膜周部室间隔缺损（perimembranous ventricularseptal defect，pmVSD）介入治疗策略指导下，观
察后续pmVSD介入封堵术后传导阻滞发生状况，分析其危险因素和预防措施。方法：分析2012年1月—2020年7月间成功接
受介入封堵的 196 例 pmVSD 患者术后发生传导阻滞的情况，采用 Logistic 单因素和多因素回归模型进行危险因素分析和探
索。结果：术后新发传导阻滞18例（18/196，9.2%），包括完全性和不完全性右束支传导阻滞、左前分支传导阻滞、室内传导阻
滞和Ⅰ度房室传导阻滞，未发生完全性左束支传导阻滞及高度房室传导阻滞，所有术后传导阻滞均在2个月内恢复。基底封
堵组传导阻滞发生率（12.7%，17/134）较瘤内封堵组（1.6%，1/62）更高（P=0.014）。在基底封堵亚组，pmVSD上缘与主动脉瓣右
冠瓣的距离（distance from the aortic valve to the defect，DAVD）越长（P=0.015）、破口直径越大（P=0.022），术后发生传导阻滞的
风险越大。结论：基底封堵组传导阻滞发生率较高。在基底封堵组，DAVD及破口直径是术后传导阻滞发生的独立影响因素。
［关键词］ 膜周部室间隔缺损；介入治疗；传导阻滞；危险因素
［中图分类号］ R541.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）02⁃200⁃06
doi：10.7655/NYDXBNS20220209

Reanalysis of risk factors of post ⁃ procedure heart blocks after transcatheter closure of

perimembranous ventricular septal defect
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XING Zilin ，ZHANG Hao ，SUN Wei ，ZHANG Haifeng ，YONG Yonghong ，YANG Rong ，SHENG Yanhui 1，2* ，
KONG Xiangqing 1，2
1 Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；Center for
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Cardiovascular Diseases，the Affiliated Suzhou Hospital of Nanjing Medical University，Gusu School，Nanjing Medical
University，Suzhou 215008，China
［Abstract］ Objective： This study aims to observe the condition of post ⁃ procedure heart blocks after transcatheter closure of
perimembranous ventricular septal defect（pmVSD）under the guidance of the new treatment strategy of transcatheter closure of
pmVSD based on previous experience. To investigate the risk factors and prevent post⁃procedure heart blocks. Methods：The clinical
data of the 196 patients who successfully underwent transcatheter closure of pmVSD from January 2012 to July 2020 were analyzed.
Univariate and multivariate logistic regression models were used to analyze and explore the risk factors. Results：Total 18 patients（18/
196，9.2%）developed post ⁃ procedure heart blocks，including complete and incomplete right bundle branch block，left anterior
fascicular block，intraventricular block and first degree atrioventricular block. No complete left bundle branch block and high⁃degree
atrioventricular block occurred. All post⁃procedure heart blocks recovered within 2 months. The incidence of heart blocks in the basal
occlusion group（12.7% ，17/134）was higher than the intratumoral occlusion group（1.6% ，1/62）（P=0.014）. The analysis of basal
occlusion group showed that distance from the aortic valve to the defect（DAVD）（P=0.015）and the diameter of the defect（P=0.022）
were positively related to post⁃procedure heart blocks. Conclusion：The incidence of heart blocks is higher in the basal occlusion
group. In the basal occlusion group，DAVD and the diameter of the defect are independent risk factors of post⁃procedure heart blocks.
［Key words］ ventricular septal defect；transcatheter closure；heart block；risk factor
［J Nanjing Med Univ，2022，42（02）：200⁃205］

［基金项目］ 南京医科大学姑苏学院引进人才项目（GSRCKY20210203）
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通信作者（Corresponding author），E⁃mail： yhsheng@njmu.edu.cn