房间隔缺损患者经导管堵闭术后早期心电图变化及意义.DOCVIP

房间隔缺损介入治疗前后心电图变化规律探讨 贵州省人民医院心内科（贵阳 550002）张长海1 杨天和 吴立荣 张陈匀 杨永曜 　【摘要】 目的　观察房间隔缺损（ASD）介入封堵术前后心电图（ECG）的变化规律及其机制探讨。方法　对比研究了112例（男49例，女63例，平均年龄23.75±15.34岁）ASD患者经导管介入封堵术前与术后3天、1个月、3个月、6个月随访的12导联ECG变化特点。ECG观察指标包括心率(HR)、P-R间期、Ⅱ导联P波振幅(PⅡ )、P波离散度（Pd）、QRS时限、额面QRS电轴、QT离散度（QTd）、RV1+SV5、RV5+SV1、TV5、TV6振幅等,并观察有无心律失常发生。结果　ASD封堵术后6个月HR明显减慢，P-R间期缩短，PⅡ 、RV1+SV5振幅减低，QRS时限缩短，而RV5+SV1振幅术后增加。Pd 、QTd 均较术前明显减小。术后未发生严重心律失常。结论　经导管介入治疗ASD安全有效,不仅能达到病理解剖上的封堵，且随着左向右分流阻断，术后心电图明显改善。ECG随访观察有助于临床疗效评价。 关键词　房间隔缺损　经导管封堵术 心电图 Study of the electrocardiographic changes before and after transcatheter closure of atrial septal defects Zhang Changhai, Yang Tianhe, Wu lirong, et al. Department of cardiology, Guizhou Provincial People,s Hospital, Guiyang 550002 [Abstract] Objective To investigate the electrocardiographic changes of heart before and after percutaneous closure of atrial septal defect (ASD), as well as to discuss the related mechanism. Methods A total of 112 patients received percutaneous closure of ASD (male 49, female 63), at a median age of 23.75±15.34(range 3-70 years), were recorded and measured standard 12-lead electrocardiography (ECG) before closure , 3 days,1 month,3 months,6 months after closure. The items of ECG included heart rate(HR), P-R interval, QRS duration, the amplitude of P wave at lead Ⅱ (PⅡ ) and the amplitude of RV1+SV5,RV5+SV1,TV5,TV6, the arrhythmias were observed too. Results In all patients, HR, the P-R interval, the amplitude of RV1+SV5, QRS duration, PⅡ, Pd and QTd decreased significantly at 6 months after closure,accompanied the amplitude of RV5+SV1 increased gradually. There was no serious arrhythmias associated with the procedure. Conclusion Transcatheter closure of ASD using the domestic-made septal occluder device is safe and effective. The operation not only can close the defect in anatomy, but also can greatly normalize the electrical changes of heart with the disappearance of shunt after closure. ECG may play an important role to evaluate the clinical