【摘要】：目的： 通過食道超聲引導經胸微創(chuàng)治療室間隔缺損,實時監(jiān)測VSD封堵前后心內血流動力學的變化,來確定該方法可行性及優(yōu)越性,并對這個方法進行一定的臨床研究。 方法： 選擇我院在2012年3月-2012年7月間共50名VSD患兒,其中男性28例,女性22例,年齡11月-8歲,體重6～28kg。其中膜部VSD42例,肌部VSD5例,肺瓣下VSD3例。患兒行全身麻醉后,采用TEE引導室間隔缺損封堵器來封堵VSD。封堵前通過TEE再次觀測VSD的位置及其與鄰近結構的位置關系并記錄,通過脈沖多普勒測量右上肺靜脈血流頻譜,記錄S、D、A。封堵后再次測量右上肺靜脈血流頻譜,記錄S、D、A。記錄手術中放置封堵器的時間,出血量。記錄術前及術后經TTE測量的傳統(tǒng)心功能參數(shù)EF、FS、LVDD的值。 結果： 50例患兒中有三例因術中TEE再次檢查確認不適合封堵而放棄封堵,其余封堵全部成功。傳統(tǒng)心功能參數(shù)EF、FS、LVDD在術前術后無顯著性差異(P0.05),肺靜脈血流頻譜S、D、A在術前術后相比有顯著差異(P0.05)。 結論： TEE可以進一步對該類手術病人進行篩選,能夠實時動態(tài)監(jiān)測手術對心臟的影響,指導外科醫(yī)師采取適當術式安全的完成手術,并能在術后即刻評價手術效果,在此類手術中具有較高應用價值。術中經TEE行肺靜脈血流頻譜檢測,可以早期發(fā)現(xiàn)手術中心功能的變化,從而進一步提高手術的安全性。
[Abstract]:Objective: to determine the feasibility and superiority of transthoracic minimally invasive treatment of ventricular septal defect (VSD) by transesophageal ultrasound guidance and real-time monitoring of the changes of intracardiac hemodynamics before and after VSD occlusion. The clinical study of this method was carried out. Methods: a total of 50 children with VSD were selected from March 2012 to July 2012, including 28 males and 22 females, aged from November to 8, with a body weight of 6 ~ 28kg. Of them, there were VSD42 in membrane, VSD5 in muscle and VSD3 in subvalvular lung. After general anesthesia, TEE guided ventricular septal defect occluder was used to block VSD.. Before occlusion, the position of VSD and its relationship with adjacent structures were observed again by TEE, and the right superior pulmonary vein blood flow spectrum was measured by pulse Doppler. Right superior pulmonary vein blood flow spectrum was measured again after occlusion. Record the time when the occluder was placed and the amount of blood lost during the operation. The EF,FS,LVDD values of traditional cardiac function parameters measured by TTE before and after operation were recorded. Results: three of the 50 children gave up the occlusion because of the reexamination of TEE during operation, and the others were all successful. There was no significant difference in traditional cardiac function parameters before and after operation (P0.05), but there was significant difference in pulmonary venous blood flow spectrum (P0.05) before and after operation (P0.05). Conclusion: TEE can further screen the patients of this kind of operation, monitor the effect of operation on heart in real time and dynamically, instruct the surgeon to complete the operation safely, and evaluate the effect of operation immediately after operation. It has high application value in this kind of operation. Intraoperative pulmonary venous blood flow spectrum detection via TEE can detect the change of operation center function early, and further improve the safety of the operation.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R726.1

【參考文獻】

相關期刊論文 前10條

1 張玉順;室間隔缺損介入治療和評價[J];介入放射學雜志;2005年S1期

2 劉守蓮,武連芬,朱維平,逄坤靜;冠心病左心功能不全時肺靜脈血流頻譜的研究[J];臨床心血管病雜志;2003年03期

3 張玉順,代政學,賈國良,劉建平,王小燕;國產雙盤狀封堵器經導管治療膜部室間隔缺損療效的初步評價[J];心臟雜志;2002年06期

4 豐麗英,彭亞丁,宋玉麗,郭好學,張金華,姜如同,閆慧麗;超聲心動圖在Amplatzer封堵器治療室間隔缺損中的價值[J];中國超聲醫(yī)學雜志;2003年02期

5 李軍,張軍,姚志勇,張玉順,劉建平,左健,朱霆;經胸超聲心動圖在室間隔缺損封堵術中的應用研究[J];中國超聲醫(yī)學雜志;2003年10期

6 泮思林;邢泉生;榮佑寶;曹倩;段書華;侯可峰;武欽;;經食管超聲心動圖在膜周部室間隔缺損鑲嵌治療中的應用[J];中國超聲醫(yī)學雜志;2008年05期

7 馬寧;李治安;孟旭;楊婭;;經食管實時三維超聲心動圖在二尖瓣手術中的應用價值[J];中國超聲醫(yī)學雜志;2008年07期

8 劉迎龍,張宏家,孫寒松,李守軍,閆軍,蘇俊武,于存濤;右胸外側小切口小兒先天性心臟畸形矯治術793例體會[J];中國循環(huán)雜志;2000年04期

9 李衛(wèi)萍,秦永文,王爾松,趙仙先;超聲心動圖在室間隔膜周部缺損經導管封堵術中篩選病例的作用[J];中華超聲影像學雜志;2003年05期

10 邢泉生;莊忠云;泮思林;段書華;榮佑寶;李生德;侯可峰;武欽;;應用新型輸送系統(tǒng)經胸微創(chuàng)封堵膜周部室間隔缺損[J];中華實驗外科雜志;2007年09期

，

本文編號：2209508