本文選題：兒童 + 室間隔缺損��； 參考：《吉林大學(xué)》2013年碩士論文

【摘要】：目的：對(duì)450例VSD患兒進(jìn)行回顧性研究，探討與小兒VSD自然愈合過程相關(guān)的影響因素，更好的了解VSD患兒的預(yù)后及轉(zhuǎn)歸情況。 方法：選擇2005年1月-2012年12月就診于我院，且生后0-6個(gè)月在我院行CDE檢查，診斷存在VSD的450例患兒，并對(duì)其進(jìn)行調(diào)查，調(diào)查時(shí)間最少為1年，最多4年；根據(jù)最終調(diào)查結(jié)果，患兒按照VSD的自然發(fā)展過程分為愈合組和未愈組，其中愈合組為研究組，未愈組為對(duì)照組；有68例VSD患兒在隨訪過程中行手術(shù)或介入治療，不能計(jì)入VSD自然愈合統(tǒng)計(jì)結(jié)果，故對(duì)VSD自然愈合相關(guān)影響因素進(jìn)行統(tǒng)計(jì)學(xué)分析時(shí)，剔除這些病例。但這部分患兒的統(tǒng)計(jì)資料計(jì)入VSD患兒的預(yù)后及轉(zhuǎn)歸分析中。運(yùn)用t檢驗(yàn)的方法對(duì)愈合組與未愈組患兒0-6個(gè)月時(shí)VSD的直徑、AOD、MPA、LAD、RVD、LVEDD及呼吸系統(tǒng)感染積分的均值±標(biāo)準(zhǔn)差進(jìn)行組間比較；運(yùn)用2檢驗(yàn)的方法對(duì)以下因素進(jìn)行統(tǒng)計(jì)學(xué)分析，包括：VSD合并其他先天性心臟疾�。ˋSD、PDA、PH等）、復(fù)雜型CHD伴VSD、PAVP、缺損部位（pmVSD、MVSD、干下型VSD、混合型VSD）、膜部瘤形成、C/T、DS患兒伴有VSD、VSD合并高膽紅素血癥、母孕后前3個(gè)月患兒父母嗜煙、嗜酒、服用藥物、接觸放射線等；通過t檢驗(yàn)及2檢驗(yàn)分析，篩選出15個(gè)與VSD自然愈合相關(guān)因素，，再應(yīng)用二項(xiàng)分類Logistic對(duì)15個(gè)因素進(jìn)行逐步回歸分析。 結(jié)果：患兒3歲內(nèi)的VSD自然愈合率為87.35%，3歲以后VSD自然愈合的比率明顯下降。應(yīng)用獨(dú)立樣本t檢驗(yàn)的方法對(duì)相關(guān)因素的平均值±標(biāo)準(zhǔn)差（x±s）進(jìn)行兩組間的比較，結(jié)果顯示：兩組間小型VSD、中型VSD、MPA、LAD、RVD、LVEDD、呼吸系統(tǒng)感染積分的組間比較差異有統(tǒng)計(jì)學(xué)意義；AOD、大型VSD，IVST的組間比較雖有差異，但均無統(tǒng)計(jì)學(xué)意義（p0.05）。應(yīng)用2檢驗(yàn)對(duì)相關(guān)因素進(jìn)行兩組間的比較，結(jié)果如下：VSD合并PDA、復(fù)雜CHD伴有VSD、PAVP1.05m/s、pmVSD、MVSD、VSD伴有膜部瘤形成、VSD患兒C/T正常者及VSD伴有貧血者，差異有統(tǒng)計(jì)學(xué)意義（p0.05）。而VSD伴有ASD、VSD合并PH、干下型VSD、混合型VSD、DS伴有VSD患兒、VSD合并高膽紅素血癥、父母在母孕后前3個(gè)月嗜煙、嗜酒、接觸放射線及服用藥物患兒的組間比較差異無統(tǒng)計(jì)學(xué)意義（p0.05）。將上述單因素分析有意義的15個(gè)變量引入二項(xiàng)分類Logistic回歸模型，選入和剔除變量的顯著性水平分別為0.05和0.10，最終篩選出9個(gè)變量：PDA、復(fù)雜CHD、PAVp、pmVSD、MVSD、小型VSD、膜部瘤的形成、C/T，感染積分。對(duì)行手術(shù)或介入治療的68例VSD患兒的調(diào)查結(jié)果提示，術(shù)后6個(gè)月內(nèi)發(fā)生殘余分流的患兒1例，呼吸道感染2例治愈，21例心律失�；純盒g(shù)后6個(gè)月時(shí)僅有1例房室傳導(dǎo)阻滯存在，其余患兒恢復(fù)正常，故總體預(yù)后良好。調(diào)查過程中死亡的7例VSD患兒，均為復(fù)雜CHD伴有VSD，患兒早期即出現(xiàn)了較多的并發(fā)癥，反復(fù)感染，最后死于心力衰竭和呼吸衰竭。 結(jié)論：1.小型VSD、pmVSD、MVSD、膜部瘤的形成、心臟大小正常及PAVP1.05m/s，具備上述特點(diǎn)或大部分特點(diǎn)的VSD患兒，缺損預(yù)后及轉(zhuǎn)歸良好，在患兒心功能良好，生長發(fā)育尚可的情況下，可暫緩手術(shù)或介入治療，定期復(fù)查CDE至學(xué)齡期。2.合并PDA、復(fù)雜型CHD伴有VSD、干下型VSD、大型VSD、DS伴有VSD患兒及呼吸道感染情況重，VSD預(yù)后及轉(zhuǎn)歸較差，應(yīng)盡早手術(shù)治療。3.母孕后前3個(gè)月患兒父母嗜煙、嗜酒、接觸放射線、服用藥物未發(fā)現(xiàn)與VSD自然愈合有關(guān)。4.本文調(diào)查結(jié)果提示VSD手術(shù)或介入治療總體預(yù)后良好。
[Abstract]:Objective: a retrospective study of 450 children with VSD was carried out to explore the factors related to the natural healing process of VSD in children and to better understand the prognosis and prognosis of children with VSD.
Methods: in December -2012 January 2005, in our hospital in December, and 0-6 months after birth in our hospital, 450 cases of VSD were diagnosed and investigated. The investigation time was at least 1 years, and the maximum was 4 years. According to the final survey results, the children were divided into the healing group and the non healing group according to the natural development process of VSD. The healing group was studied. In the group, the non healing group was the control group; 68 cases of VSD children were operated or intervened during the follow-up process, and the statistical results of VSD natural healing could not be counted. Therefore, when the related factors of natural healing of VSD were statistically analyzed, these cases were eliminated. But the statistical data of this part of the children were included in the prognosis and outcome analysis of the children of VSD. The use of T The method of test was used to compare the VSD diameter, AOD, MPA, LAD, RVD, LVEDD and the mean standard deviation of the respiratory system infection score at 0-6 months in the healing group and the non healing group. The following factors were statistically analyzed with the method of 2 test, including the combination of VSD with other congenital heart diseases (ASD, PDA, PH, etc.), and the complex CHD companion VSD. AVP, the defect site (pmVSD, MVSD, VSD, mixed VSD), membrane tumor formation, C/T, DS children with VSD, VSD combined with hyperbilirubinemia, the first 3 months after mother pregnancy, parents smoking, drinking, taking drugs, exposure to radiation and so on; through t test and 2 test analysis, select 15 related factors of VSD natural healing, and then apply two classification Log. A stepwise regression analysis of 15 factors was carried out by istic.
Results: the natural healing rate of VSD within 3 years of age was 87.35%, and the ratio of natural healing of VSD decreased significantly after 3 years of age. The mean value + standard deviation (x + s) of independent sample t test was compared between the two groups. The results showed that the two groups were small VSD, medium VSD, MPA, LAD, RVD, LVEDD, between groups of respiratory system infection. The difference was statistically significant, although there were differences in AOD, large VSD and IVST, but there was no statistical significance (P0.05). The results were as follows: VSD combined with PDA, complex CHD with VSD, PAVP1.05m/s, pmVSD, MVSD, VSD accompanied by the formation of membrane tumor. The difference was statistically significant (P0.05), while VSD was accompanied by ASD, VSD combined with PH, VSD, mixed VSD, DS with VSD, VSD combined with hyperbilirubinemia, parents were smoking in the first 3 months after mother pregnancy, alcohol, exposure to radiation and children taking drugs were not statistically significant (P0.05). The above single factor analysis was 15. Two classification Logistic regression models were introduced. The significant levels of selection and elimination were 0.05 and 0.10, and 9 variables were selected: PDA, complex CHD, PAVp, pmVSD, MVSD, small VSD, membranous tumor formation, C/T, infection integral. The results of 68 cases of VSD in 68 cases of operation or interventional therapy were found within 6 months after operation. 1 children with residual shunt, 2 cases of respiratory infection and 21 cases of arrhythmia in 6 months after operation, only 1 cases of atrioventricular block existed, and the rest of the children recovered to normal, so the overall prognosis was good. 7 cases of VSD children died in the investigation were complex CHD accompanied by VSD. The later died of heart failure and respiratory failure.
Conclusion: 1. small VSD, pmVSD, MVSD, membrane tumor formation, normal heart size and PAVP1.05m/s, with the above characteristics or most of the characteristics of children with VSD, the prognosis and prognosis are good. Under the condition of good heart function and the growth and development of children, the operation or interventional therapy can be postponed, and CDE to the school age.2. with PDA, complex CH D with VSD, lower VSD, large VSD, DS with VSD children and respiratory infection, VSD prognosis and poor prognosis, should be performed as early as possible for the first 3 months after.3. mother pregnancy, parents' smoking, alcoholism, exposure to radiation, and medication not found to be associated with VSD natural healing.4.: the findings suggest VSD or interventional therapy overall prognosis Good.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R725.4

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