本文選題：肺動脈瓣狹窄 + 經(jīng)皮球囊肺動脈瓣成形術(shù)��； 參考：《重慶醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：分析經(jīng)皮球囊肺動脈瓣成形術(shù)（PBPV）治療單純性肺動脈瓣狹窄(PS)的療效，提高治愈率，減少并發(fā)癥。 方法：回顧性分析重慶醫(yī)科大學(xué)附屬兒童醫(yī)院于2004年7月～2011年6月采用PBPV術(shù)治療的75例PS患兒的臨床資料，比較擴張前后肺動脈、右心室壓力變化以及球囊的選擇情況，術(shù)后并發(fā)癥情況。 結(jié)果：1.本組PS患者的年齡3歲51例，占總例數(shù)的68%，~3歲24例，占總例數(shù)的32%，男性43例（57%）、女性32例（43%），其比例約為1.3:1；輕度PS40例（53%），中度PS32例（43%），重度PS3例（4%）。 2.兒童PS常見的癥狀為多汗（23/75），吃奶中斷或嗆奶（10/75），活動后氣促或是活動耐力低于同齡兒（14/75），重者出現(xiàn)蹲踞（1/75），影響生長發(fā)育，出現(xiàn)生長發(fā)育遲緩；患者常伴發(fā)上呼吸道感染（16/75）、 肺炎（8/75）及腹瀉�。�1/75）等；體檢發(fā)現(xiàn)心前區(qū)或胸骨左緣第2-3 肋間2-4級吹風(fēng)樣或噴射樣雜音（75/75），并向腋下或頸部傳導(dǎo)（14/75）,P2減弱（19/75），一部分伴有震顫（11/75）；患兒往往心前*本課題受國家十一五計劃資助(2007BAI05B03)區(qū)無隆起（75/75）；中至重度PS常�？梢娮辖C（13/75）。 3.本組PS合并先天性心臟病如房間隔缺損（6/75）、動脈導(dǎo)管未閉（3/75），肺動脈狹窄（2/75）等；同時偶有伴發(fā)缺鐵性貧血（1/75）及腦癱（1/75）等。 4.PS患者典型的胸片表現(xiàn)為肺少血:肺血管紋理偏細(xì)或稀疏(40/75)，心影增大，特別是右室和右房擴大，心胸比增大（大于0.5）(26/75)；同時常常可見到肺動脈段隆起(24/75)；部分輕度中度的PS的胸片也可表現(xiàn)為無明顯異常(26/75)。此外對于合并呼吸道感染的PS患兒也可表現(xiàn)為肺紋理增多(9/75)。 5.PS的心電圖常見的表現(xiàn)為電軸右偏、右心室肥大（34/75）；合并心律失常，常見的有：竇性心律不齊（22/75），QT高值（6/75），ST段改變（3/75），T波改變（4/75）,不典型不完全性右束支傳導(dǎo)阻滯（3/75）,低電壓傾向（2/75），不完全性右束支傳導(dǎo)阻滯（1/75），Ⅰ度房室傳導(dǎo)阻滯（1/75），室性早搏（偶發(fā)）（1/75），u波改變（1/75），房室交界性心律（1/75），電軸左偏（1/75）。 此外，也有相當(dāng)一部分的PS心電圖未見明顯異常（20/75）。 PBPV術(shù)后患兒術(shù)后電軸右偏、右心室肥大較術(shù)前明顯改善；Ⅰ度房室傳導(dǎo)阻滯及室性早搏（偶發(fā)）則于術(shù)后消失；新出現(xiàn)了完全性右束支阻滯（1例）、QT延長（2例）及PR高值（3例），無嚴(yán)重心律失常出現(xiàn)。 6.本組75例PS術(shù)前右室收縮壓為(70.24±23.54)mmHg(1mmHg=0.133kPa)，術(shù)后即刻心導(dǎo)管檢測降為(34.75±9.12)mmHg(P0.01)；跨肺動脈瓣壓力階差（△P）術(shù)前為(49.41±22.57)mmHg，術(shù)后即刻心導(dǎo)管檢測降為(11.33±7.25)mmHg(P0.01)；術(shù)后即刻心導(dǎo)管檢測跨肺動脈瓣壓力階差25mmHg達(dá)94.67％。術(shù)后24小時經(jīng)超聲測定△P為(23.04±9.80)mmHg；術(shù)后1月、術(shù)后3月、術(shù)后6月及術(shù)后1年超聲測定△P均較術(shù)后24小時明顯下降；右室造影肺動脈瓣環(huán)直徑為（13.76±3.18）mm，所選球囊大小為（16.70±3.68）mm；無嚴(yán)重并發(fā)癥和死亡病例發(fā)生。 7.術(shù)后隨訪患兒多汗、吃奶中斷或嗆奶、活動后氣促均較術(shù)前明顯緩解，生長發(fā)育改善；體檢發(fā)現(xiàn)心臟雜音明顯減弱或消失. 結(jié)論：PBPV治療兒童PS安全有效。嚴(yán)格掌握適應(yīng)證，，規(guī)范操作，結(jié)合術(shù)前超聲和右室造影判斷肺動脈瓣環(huán)大小，選擇合適大小球囊是介入成功的關(guān)鍵。對可疑PS患者早診斷、早治療，對改善兒童生長發(fā)育及預(yù)后有重要意義。
[Abstract]:Objective: to analyze the efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) in the treatment of simple pulmonary valve stenosis (PS), improve the cure rate and reduce complications.
Methods: the clinical data of 75 children with PS in the Affiliated Children's Hospital of Medical University Of Chongqing from July 2004 to June 2011 were analyzed. The changes of pulmonary artery, right ventricular pressure, selection of balloon and postoperative complications were compared before and after the expansion of PBPV.
Results: 1. the age of 1. patients was 3 years old and 51 cases, accounting for 68% of the total number, 24 cases of ~3 years old, 32% of the total number, 43 men (57%) and 32 women (43%), with a proportion of about 1.3:1, mild PS40 (53%), moderate PS32 (43%), and severe PS3 cases (4%).
2. children's common symptoms of PS are perspiration (23/75), milk interruption or choking (10/75), after activity or activity endurance is lower than the same age (14/75), and the heavy crouching (1/75), affecting growth and development, growth retardation, patients often associated with upper respiratory infection (16/75),
Pneumonia (8/75) and diarrhoeal disease (1/75); physical examination found the precordial area or the left margin of sternum 2-3.
The 2-4 stage of the intercostal blower or spray like murmurs (75/75), conduction (14/75) to the underarm or neck (14/75), P2 weakened (19/75), and a part accompanied by tremor (11/75); children tend to be subject to the national 11th Five-Year program funded (2007BAI05B03) area without a bulge (75/75); moderate to severe PS is often seen in cyanosis (13/75).
3. PS combined with congenital heart disease such as atrial septal defect (6/75), patent ductus arteriosus (3/75), pulmonary artery stenosis (2/75), and occasionally accompanied by iron deficiency anemia (1/75) and cerebral palsy (1/75).
The typical chest radiographs of 4.PS patients were pulmonary less blood: the pulmonary vascular texture was thinner or thinner (40/75), the heart shadow increased, especially the right ventricle and right chamber enlargement, the heart ratio increased (more than 0.5) (26/75), and the pulmonary artery segment (24/75) was often seen; some mild moderate PS chest films could also show no obvious abnormality (26/75). In addition, the combination of the chest radiographs was also uncommon. Respiratory tract infection in children with PS can also be manifested as increased lung markings (9/75).
The common manifestations of 5.PS's electrocardiogram were right deviation of electric axis and right ventricular hypertrophy (34/75); combined arrhythmia, sinus arrhythmia (22/75), high value of QT (6/75), ST segment change (3/75), T wave change (4/75), atypical incomplete right bundle conduction retardation (3/75), low voltage tendency (2/75), incomplete right bundle branch block (1/75), I degree Atrioventricular block (1/75), ventricular premature beat (Ou Fa) (1/75), U wave change (1/75), atrioventricular junctional rhythm (1/75), left axis deviation (1/75).
In addition, a significant part of PS electrocardiogram showed no obvious abnormality (20/75).
The right ventricular hypertrophy and right ventricular hypertrophy after PBPV were obviously improved than that before operation, and I degree atrioventricular block and ventricular premature beat (Ou Fa) disappeared after operation; new complete right bundle branch block (1 cases), QT lengthening (2 cases) and PR high value (3 cases), no serious arrhythmia appeared.
6. the right ventricular systolic pressure was (70.24 + 23.54) mmHg (1mmHg=0.133kPa) before PS, and the immediate cardiac catheterization was reduced to (34.75 + 9.12) mmHg (P0.01) immediately after operation, and the pressure step difference (delta P) was (49.41 + 22.57) mmHg before operation. The immediate cardiac catheterization was reduced to (11.33 + 7.25) mmHg (P0.01) immediately after operation, and immediately after the operation, the cardiac catheterization was used to detect the cross pulmonary valve. The pressure order difference 25mmHg was (23.04 + 9.80) mmHg by ultrasonography 24 hours after the operation. In January, March after operation, in June and 1 years after operation, Delta P was significantly lower than that of 24 hours after operation; the diameter of pulmonary valvular ring in right ventricle was (13.76 + 3.18) mm and the size of the balloon was (16.70 + 3.68) mm, without serious complications and death. Case of death.
After 7., the children were followed up with hyperhidrosis, and the milk was interrupted or choked. After the activity, the growth and development were obviously relieved and the growth and development were improved, and the heart murmur was obviously weakened or disappeared.
Conclusion: PBPV is effective and effective in the treatment of children's PS. It is important to strictly master the indications, standardize the operation, judge the size of the pulmonary valvular ring with preoperative ultrasound and right ventriculography, and choose the right balloon for the success of the intervention. Early diagnosis and early treatment for suspected PS patients are of great significance to improve the growth and prognosis of children.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.4

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