發(fā)布時間：2018-08-28 13:20

【摘要】：目的： 通過食道超聲引導(dǎo)經(jīng)胸微創(chuàng)治療室間隔缺損,實時監(jiān)測VSD封堵前后心內(nèi)血流動力學(xué)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�；純盒腥砺樽砗�,采用TEE引導(dǎo)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(jié)構(gòu)的位置關(guān)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(shù)中放置封堵器的時間,出血量。記錄術(shù)前及術(shù)后經(jīng)TTE測量的傳統(tǒng)心功能參數(shù)EF、FS、LVDD的值。 結(jié)果： 50例患兒中有三例因術(shù)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(shù)前術(shù)后無顯著性差異(P0.05),肺靜脈血流頻譜S、D、A在術(shù)前術(shù)后相比有顯著差異(P0.05)。 結(jié)論： TEE可以進一步對該類手術(shù)病人進行篩選,能夠?qū)崟r動態(tài)監(jiān)測手術(shù)對心臟的影響,指導(dǎo)外科醫(yī)師采取適當術(shù)式安全的完成手術(shù),并能在術(shù)后即刻評價手術(shù)效果,在此類手術(shù)中具有較高應(yīng)用價值。術(shù)中經(jīng)TEE行肺靜脈血流頻譜檢測,可以早期發(fā)現(xiàn)手術(shù)中心功能的變化,從而進一步提高手術(shù)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(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R726.1

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