【摘要】：目的分析比較不同類型的國產(chǎn)封堵器封堵小兒膜部瘤型室間隔缺損(pm VSD)的可行性、安全性和療效,為小兒膜部瘤型室間隔缺損尋找最佳治療方案。方法選擇2013年3月-2015年3月在我院查體聽診心臟雜音且經(jīng)胸超聲心動(dòng)圖(transthoracic echocardiography,TTE)篩查并經(jīng)介入造影確診膜部瘤型室間隔缺損(pm VSD)的68例患兒作為研究對(duì)象。按照手術(shù)時(shí)選用封堵器的類型隨機(jī)分為兩組:對(duì)稱型封堵器進(jìn)行封堵30例(對(duì)稱組);小腰大邊封堵器進(jìn)行封堵38例(小腰大邊組)。術(shù)前行三大常規(guī)、肝腎功心肌酶等檢驗(yàn)、心臟彩超、心電圖檢查,術(shù)后24小時(shí),1月,3月,6月,12月入院復(fù)查心臟彩超、心電圖、心臟正側(cè)位片等檢查,比較兩組術(shù)前資料(包括年齡、體重、VSD直徑、術(shù)前心胸比值、手術(shù)時(shí)間)差異,比較兩組術(shù)后封堵的效果、術(shù)后住院時(shí)間、成功率和并發(fā)癥(主要包括殘余分流、瓣膜返流、心律失常)發(fā)生率的差異。結(jié)果術(shù)前資料,其中男32例,女36例;年齡2.6-12歲(5±2.2歲),體重11 43Kg(15.4±5.1 Kg),身高90 146cm(101±10.2 cm),對(duì)比兩組術(shù)前資料,兩組患兒的年齡、體重、VSD直徑及心胸比值、手術(shù)時(shí)間方面差異不顯著(P0.05)。68例患兒術(shù)前存在心律失常6例,對(duì)稱組、小腰大邊組各3例(包括CRBBB2例、IRBBB2例、LAFB1例、I°AVB1例)。68例患兒中封堵成功60例,封堵失敗或放棄封堵8例,其中,小腰大邊組(36/38)封堵成功率高于對(duì)稱組(24/30)。術(shù)后心臟大小、LVDd均較術(shù)前減小,但無統(tǒng)計(jì)學(xué)差異(P0.05),分別對(duì)比不同時(shí)間點(diǎn)兩組的心臟大小及心臟收縮功能的各項(xiàng)指標(biāo),均無顯著性差異(P0.05)。術(shù)后早期資料分析,兩組均無死亡病例,無完全性房室傳導(dǎo)阻滯、封堵器脫落或移位、心內(nèi)膜炎等嚴(yán)重并發(fā)癥發(fā)生。術(shù)后早期,對(duì)稱組新發(fā)心律失常4例(CRBBB 1例、IRBBB 2例,CLBBB 1例),術(shù)后瓣膜返流6例(少量三尖瓣返流5例,主動(dòng)脈瓣返流由微量加重到少量反流1例),殘余分流2例,均為少量分流;小腰大邊組新發(fā)心律失常2例(CRBBB 1例、IRBBB1例),瓣膜返流3例(少量三尖瓣返流2例,主動(dòng)脈瓣返流由微量加重到少量反流1例),無殘余分流。60例患兒中,共完成隨訪57例,3例失訪。所有隨訪患兒均無死亡病例,無封堵器脫落、封堵器移位、無重度PAH發(fā)生。長期隨訪數(shù)據(jù)顯示,小腰大邊組無殘余分流,新發(fā)三尖瓣返流1例,新發(fā)IRBBB 1例;對(duì)稱組仍存在殘余分流2例,新發(fā)三尖瓣返流2例,均為少量返流,CRBBB 1例;2組比較,主動(dòng)脈瓣返流較術(shù)后早期無加重及新發(fā)病例。結(jié)論小腰大邊封堵器治療pm VSD成功率高,并發(fā)癥少,療效可靠,與對(duì)稱封堵器相比有明顯的優(yōu)勢。但本組數(shù)據(jù)病例數(shù)目較少,隨訪時(shí)間短,部分資料隨訪不夠全面,因此,遠(yuǎn)期療效仍需要更多、更系統(tǒng)的隨訪資料進(jìn)一步觀察。
[Abstract]:Objective to compare the feasibility, safety and efficacy of different types of domestic occluder in the treatment of membranous neoplastic ventricular septal defect (pm VSD) in children. Methods Sixty-eight children with membranous neoplastic ventricular septal defect (pm VSD) were selected from our hospital from March 2013 to March 2015, who were screened by transthoracic echocardiography and confirmed by interventional angiography. According to the type of occluder used in the operation, they were randomly divided into two groups: 30 cases with symmetrical occluder (symmetrical group) and 38 cases with small lumbar side occluder (small lumbar side group). Before operation, three major routine examinations were performed, including liver and kidney function and myocardial enzyme test, echocardiography, electrocardiogram, 24 hours, 1 month, 3 months, 6 months and 12 months after operation, and the examination of echocardiography, electrocardiogram, positive and lateral radiography of the heart, etc. The preoperative data (including age, body weight, VSD diameter, preoperative cardiothoracic ratio, operative time) were compared between the two groups. The effect of closure, postoperative hospitalization time, success rate and complications (including residual shunt, valvular regurgitation) were compared between the two groups. The difference in the incidence of arrhythmias. Results preoperative data, including 32 males and 36 females, aged from 2.6 to 12 years (5 鹵2.2 years), weight 11: 43Kg (15.4 鹵5.1kg), height 90 146cm (101 鹵10. 2 cm),) were compared between the two groups. The age, body weight, diameter of VSD and cardiothoracic ratio were compared between the two groups. There was no significant difference in operative time (P0.05) .68 cases had arrhythmia before operation, 6 cases had arrhythmia before operation, 3 cases in symmetrical group and 3 cases in small waist big side group (including CRBBB2 case, IRBBB2 case, LAFB1 case, I 擄AVB1 case). Among 68 cases, 60 cases were successfully occluded, 8 cases were failed or abandoned. The success rate of occlusion in the small waist and large side group (36 / 38) was higher than that in the symmetrical group (24 / 30). Postoperative heart size and LVDd decreased compared with the preoperative, but there was no statistical difference (P0.05), the heart size and cardiac systolic function of the two groups were compared at different time points, there was no significant difference (P0.05). There were no death cases, no complete atrioventricular block, occluder loss or displacement, endocarditis and other serious complications in both groups. In the early stage of operation, 4 cases of new arrhythmia (1 case of CRBBB 1 case of IRBBB 2 cases of CLBBB), 6 cases of valve regurgitation (5 cases of tricuspid regurgitation, 1 case of aortic regurgitation), 2 cases of residual shunt. There were 2 cases of new arrhythmia (CRBBB 1 case of IRBBB1), 3 cases of valvular regurgitation (2 cases of minor tricuspid regurgitation, 1 case of aortic regurgitation from slight exacerbation to 1 case of aortic regurgitation). A total of 57 cases were followed-up and 3 cases lost. All the children were followed up with no death, no occluder loss, occluder displacement and no severe PAH. Long-term follow-up data showed that there were no residual shunt, 1 new tricuspid regurgitation and 1 new IRBBB in the small lumbar side group, and 2 cases in the symmetrical group and 2 cases in the new tricuspid regurgitation group. Aortic valve regurgitation was no more severe and new than that of early postoperative patients. Conclusion small lumbar occluder with large side occluder has high success rate, few complications and reliable therapeutic effect. It has obvious advantages over symmetrical occluder. However, the number of data in this group is relatively small, the follow-up time is short, and some of the follow-up data are not comprehensive enough. Therefore, the long-term effect still needs more and more systematic follow-up data to be further observed.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 熊榮生;鄧盛;白韜;劉毅君;;經(jīng)胸壁微創(chuàng)封堵術(shù)治療小兒室間隔膜部缺損的臨床研究[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2016年23期

2 盧芙蓉;常鳳鈴;李巖;馮俊;;超聲心動(dòng)圖診斷胎兒單純性室間隔缺損及出生后自然愈合隨訪[J];中國醫(yī)學(xué)影像學(xué)雜志;2016年02期

3 蔣威;胡暉;王飛;莫展;黃葆瑩;;經(jīng)導(dǎo)管國產(chǎn)封堵器介入治療膜周部室間隔缺損患兒的療效隨訪[J];中國現(xiàn)代醫(yī)學(xué)雜志;2016年04期

4 劉玉昊;路軍;王晶;王旭;邵一兵;張純?nèi)?夏偉;;膜周部室間隔缺損介入封堵術(shù)后心電圖的臨床分析[J];中國介入心臟病學(xué)雜志;2016年01期

5 王建銘;楊劍;崔斌;朱鮮陽;;應(yīng)用Amplazter封堵器治療膜周部室間隔缺損的進(jìn)展[J];心臟雜志;2016年03期

6 陳秒;朱達(dá);安琪;;微創(chuàng)經(jīng)胸封堵術(shù)治療干下型室間隔缺損——外科技巧及圍手術(shù)期管理[J];中國胸心血管外科臨床雜志;2015年06期

7 喬俊杰;趙文增;文冰;許華山;;經(jīng)胸微創(chuàng)封堵術(shù)在治療小兒室間隔缺損中的應(yīng)用[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年02期

8 林小彬;劉健;唐先成;付建;;經(jīng)胸微創(chuàng)室間隔缺損封堵62例療效分析[J];中國循證心血管醫(yī)學(xué)雜志;2014年05期

9 徐東進(jìn);孟慶智;葛小蔚;劉艷云;番登榜;;小腰大邊型封堵器堵閉膜部瘤室間隔缺損的臨床研究[J];介入放射學(xué)雜志;2014年06期

10 羅凱;付煒;鄭景浩;;新生兒復(fù)雜性先天性心臟病鑲嵌治療進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2013年23期

相關(guān)碩士學(xué)位論文 前1條

1 謝軍;室間隔缺損自然愈合相關(guān)因素研究[D];重慶醫(yī)科大學(xué);2013年

，

本文編號(hào)：2126942