论文部分内容阅读
目的分析经导管封堵治疗中老年继发孔型房间隔缺损(ASD)术前、术后房性快速性心律失常(atrial tachyarrhythmia,AT)情况,并探讨术后发生 AT 的危险因素。方法回顾性分析经导管封堵治疗的连续264例中老年 ASD 患者的 AT 情况,并对介入治疗术前多个指标进行单因素分析和 logistic 回归分析。结果封堵术前总的 AT 发生率为9.1%(24/264例),其中40～49岁、50～59岁、≥60岁组术前 AT 发生率分别为4.3%、14.6%和26.3%,差异有统计学意义(P<0.01)。术后总的 AT 发生率为11.0%(29/264例),与术前相比,差异无统计学意义(P>0.05)。术后发生 AT 的29例中14例术前无 AT 病史。单因素分析结果显示,发生和未发生 AT 组在年龄、术前 AT 病史、高血压、三尖瓣反流、房间隔总长度、右室舒张末期内径、左房前后径、经食管超声缺损最大径和选用封堵器直径等方面差异有统计学意义。而 logistic 多因素回归分析结果显示,年龄(OR 值2.659,95%可信区间1.080～6.547,P<0.05)、术前 AT 病史(OR 值54.311,95%可信区间9.819～300.395,P<0.01)和左房增大(OR 值8.529,95%可信区间2.162～33.643,P<0.01)是术后出现 AT 的独立危险因素。结论中老年继发孔型 ASD 经导管封堵治疗前后 AT 发生率无显著性变化。年龄、术前 AT病史和左心房扩大为术后发生 AT 的独立危险因素。
Objective To analyze the effect of transcatheter blockade on the treatment of atrial tachyarrhythmia (AT) before and after ASD in middle-aged and elderly patients and to explore the risk factors of AT after the operation. Methods A retrospective analysis of the treatment of 264 cases of middle-aged and elderly patients with ASD by catheterization AT conditions, and a number of indicators of interventional intervention before unilateral factor analysis and logistic regression analysis. Results The overall incidence of AT prior to closure was 9.1% (24/264 cases). The incidence of AT before surgery was 4.3%, 14.6% and 26.3% in 40-49, 50-59, and 60-year-old patients respectively , The difference was statistically significant (P <0.01). The overall incidence of AT after surgery was 11.0% (29/264 cases), with no significant difference compared with that before operation (P> 0.05). There were 14 cases without AT before operation in 29 cases of AT after operation. Univariate analysis showed that there was no significant difference in age, preoperative AT history, hypertension, tricuspid regurgitation, total atrial septal length, right ventricular end-diastolic diameter, left atrium anteroposterior diameter and transesophageal echocardiographic defect in AT group Diameter and the diameter of occluder and other aspects of choice was statistically significant. The logistic multivariate regression analysis showed that age (OR 2.659, 95% confidence interval 1.080 ~ 6.547, P <0.05), preoperative AT history (OR 54.311, 95% confidence interval 9.819-300.395, P 0.01 ) And left atrium enlargement (OR 8.529, 95% confidence interval 2.162-33.643, P <0.01) were independent risk factors for postoperative AT. Conclusion There was no significant change in the incidence of AT in patients with ASD secondary to endoscopic catheter occlusion. Age, preoperative AT history and left atrial enlargement were independent risk factors for postoperative AT.