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目的 探讨 1岁以内婴儿完全型肺静脉畸形引流术后心律失常的原因和治疗措施。方法 1995年 7月至 2 0 0 1年 8月 ,共收治 1岁以内完全型肺静脉畸形引流婴儿 2 4例 (男性 2 0例 ,女性 4例 )。手术矫治 2 4例 ,平均年龄 (6 0 4± 3 34 )个月 ,平均体重 (5 74± 1 2 2 )kg ;心上型 10例 (4 1 6 7% ) ,心内型 11例 (4 5 83% ) ,心下型 1例 (4 17% ) ,混合型 2例 (8 33% )。患儿均在全身麻醉、低温、体外循环下行矫治术 ,其中急诊手术 4例。术前心电图检查均为窦性心律。结果 术后早期 (30d)死亡 3例 (12 5 0 % )。 4例急诊手术婴儿均存活。术后主要并发症为室上性心律失常 10例 (4 1 6 7% ) ,其中窦性心动过缓 5例 (2 0 83% ) ,交界区性心律 4例 (16 6 7% ) ,二度房室阻滞 1例 (4 17% )。左、右心房联合切口矫治心上型完全型肺静脉畸形引流的心律失常发生率为 6 2 5 0 % (5 / 8例 )。所有心律失常婴儿经应用抗心律失常药物、心外膜临时起搏及其它对症治疗后恢复窦性心律。结论 婴儿完全型肺静脉畸形引流早期手术疗效满意。左、右心房联合切口入路行心上型矫治术可确保吻合口足够大 ,但心律失常发生率较高 ,统计学分析只与心内型有明显差异 ,与其它手术路径相比差异不明显。
Objective To investigate the causes and treatment of arrhythmia after complete pulmonary vein malformation in infants under 1 year of age. Methods From July 1995 to August 2001, 24 infants with complete anomalous pulmonary venous anomalies within 1 year were treated (20 males and 4 females). There were 24 cases underwent surgical correction, with an average age of (6.04 ± 3.34) months, mean body weight (5 74 ± 122 kg), 10 cases of cardia (41 6 7%), 11 cases of cardioembolism 4 83.3%), 1 (4 17%) subtype and 2 (8 33%) mixed patients. Children were under general anesthesia, hypothermia, cardiopulmonary bypass surgery, emergency surgery in 4 cases. Preoperative ECG were sinus rhythm. Results In the early postoperative period (30d), 3 patients died (125.0%). Four cases of emergency surgery infants survived. The main postoperative complications were supraventricular arrhythmias in 10 cases (41.67%), sinus bradycardia in 5 cases (2083%), junctional regional heart rhythm in 4 cases (16.7%), Atrioventricular block in 1 case (4 17%). The incidence of arrhythmia induced by drainage of left ventricle and right atrium was 62 52% (5 of 8 cases). All arrhythmias in infants after application of anti-arrhythmic drugs, temporary epicardial pacing and other symptomatic treatment to restore sinus rhythm. Conclusions The early operation of complete pulmonary vein malformation drainage in infants is satisfactory. Left and right atrium combined incision line type correction surgery to ensure that the anastomosis is large enough, but the incidence of arrhythmia is higher, the statistical analysis only with significant differences between the endocardial type, compared with other surgical pathways was not significantly different .