動(dòng)脈導(dǎo)管未閉合并肺動(dòng)脈高壓封堵術(shù)后隨訪研究
發(fā)布時(shí)間：2018-09-05 06:04
【摘要】：目的：先天性心臟病(Congenital Heart Disease,CHD),是小兒最常見(jiàn)的心臟疾患。常見(jiàn)類型主要有動(dòng)脈導(dǎo)管未閉(PDA patent ductus arteriosus)、房間隔缺損(ASD atrial septal defect)、室間隔缺損(VSD ventricular septal defect)、肺動(dòng)脈瓣狹窄(PS pulmonary stenosis)等。以往需要外科治療,即開(kāi)胸手術(shù)。而且多需體外循環(huán)(CPB extracorporeal circulation)、全身麻醉、輸血等,損傷較大,住院時(shí)間長(zhǎng),帶來(lái)較多術(shù)后并發(fā)癥。自20世紀(jì)60年代以來(lái),PDA封堵器治療CHD最先展開(kāi),90年代以來(lái),隨著介入器械的不斷研發(fā)及改進(jìn),介入治療操作簡(jiǎn)單、安全有效、恢復(fù)快等優(yōu)點(diǎn)日益凸顯出來(lái),并在世界范圍內(nèi)廣泛應(yīng)用。目前,關(guān)于封堵器介入治療多種CHD的療效分析比較多,PDA合并PAH的介入治療研究也日益增多,但在某些方面的研究還不系統(tǒng),本研究就應(yīng)用封堵器治療PDA合并PAH,從成功率、并發(fā)癥發(fā)生情況、殘余分流情況、術(shù)前術(shù)后肺動(dòng)脈壓變化等多方面進(jìn)行分析,通過(guò)3-12個(gè)月的隨訪來(lái)評(píng)價(jià)其療效和安全性。以期能為PDA合并PAH的介入治療適應(yīng)證提供更多理論依據(jù)。 方法：選取在2009年1月1日～2011年12月31日3年期間在山東省立醫(yī)院小兒心臟科實(shí)施PDA封堵術(shù)的患兒為研究對(duì)象,根據(jù)一定的納入及排除標(biāo)準(zhǔn),共入選60例,年齡1歲～18歲。術(shù)前均經(jīng)常規(guī)體檢、心電圖(ECG)、經(jīng)胸超聲心動(dòng)圖(TTE)、心臟正側(cè)位X線攝片等檢查確診。按照比所測(cè)PDA最窄處直徑夯2-4mm的原則選取封堵器,封堵器采用美國(guó)AGA公司的Amplatzer蘑菇傘狀PDA封堵器或國(guó)產(chǎn)蘑菇傘狀PDA封堵器。嚴(yán)格按照介入治療要求實(shí)施介入。手術(shù)結(jié)束后均抗生素預(yù)防感染治療48小時(shí)。術(shù)后24h、1、3、6、12個(gè)月復(fù)查超聲心動(dòng)圖及心電圖進(jìn)行隨訪,觀察封堵器形態(tài),殘余分流情況及肺動(dòng)脈壓改變情況及有無(wú)并發(fā)癥。 結(jié)果：60例患兒均完成封堵手術(shù),大多數(shù)患者術(shù)中即刻壓力下降明顯,壓力下降值達(dá)50%以上,術(shù)中觀察20分鐘壓力無(wú)回升。隨訪至12個(gè)月絕大多數(shù)患者肺動(dòng)脈壓力基本正常,心影形態(tài)大小接近正常。即刻手術(shù)成功率95%(無(wú)殘余分流),術(shù)前PASP、PAMP、AP均值分別為69.4±24.5mmHg、45.3±14.2mmHg、94.5±10.3mmHg,術(shù)后PASP.PAMP.AP均值分別為32.6±8.2mmHg、29.8±8.2mmHg、98.8±6.2mmHg。術(shù)前與術(shù)后PASP及PAMP差異有統(tǒng)計(jì)學(xué)意義(T=10.945,P=0.01)、(T=12.603,P=0.01)。術(shù)后PASP及PAMP顯著低于治療前。術(shù)前、術(shù)后AP差異無(wú)統(tǒng)計(jì)學(xué)意義(T=12.640,P=0.12)及動(dòng)脈血氧飽和度均值差異(P0.05)無(wú)統(tǒng)計(jì)學(xué)意義。入選的60例患者封堵后,術(shù)后1月復(fù)查TTE可見(jiàn)左房?jī)?nèi)徑(LAD)由術(shù)前30.7-5.0降為21.1±3.9(P0.01)、左室舒張末期內(nèi)徑(LVEDD)由術(shù)前49.24±6.2降為40.3±5.5(P0.05)、左室舒張末期容積(LVEDV)由術(shù)前114.7±38.9降為65.3±27.1ml(P0.01)、左室收縮末期容積(LVESV)由術(shù)前31.7±12.8m1降為25.2±10.9ml(P0.05)、左室每搏量(LVSV)由術(shù)前83.6±29.4ml降為53.1±24.6ml(P0.01)、左室射血分?jǐn)?shù)(LVEF)由術(shù)前68.1士2.6%降為63.5±5.3%(P0.05)、左室短軸縮短率(LVFS)由術(shù)前36.7±5.9%降為32.4±6.2%(P0.05)、術(shù)后3個(gè)月LAD、LVEDV、 LVEDD、LVSV、LVESV、LVFSLVEF、較術(shù)后1個(gè)月無(wú)顯著性差異(P0.05)。術(shù)后6個(gè)月LAD、LVEDV、LVEDD、LVSV、LVESV、LVFS、LVEF較術(shù)后1個(gè)月無(wú)顯著性差異(P0.05)封堵術(shù)后10分降主動(dòng)脈造影顯示無(wú)殘余分流57例,微量殘余分流2例,少量殘余分流1例。有殘余分流者中1例1月隨訪時(shí)殘余分流消失,1例隨訪12月仍存在少量殘余分流。術(shù)后并發(fā)癥少。 結(jié)論：PDA合并PAH患者行封堵器治療,技術(shù)操作簡(jiǎn)便、安全、成功率高、并發(fā)癥少,在嚴(yán)格掌握指征情況下中遠(yuǎn)期療效確切,安全性好。
[Abstract]:Objective: Congenital Heart Disease (CHD) is the most common heart disease in children. The common types are PDA patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, etc. Since 1960s, PDA occluder has been the first to treat CHD. Since 1990s, with the continuous development and improvement of interventional instruments, interventional therapy has been carried out. The advantages of simple operation, safe and effective treatment, rapid recovery and so on are becoming increasingly prominent and widely used in the world. At present, there are more and more analysis on the efficacy of interventional therapy with occluder for various CHD, and more and more research on the interventional therapy of PDA combined with PAH is also increasing, but in some aspects of the study is not systematic, this study on the application of occluder in the treatment of PDA combined. PAH was analyzed in terms of success rate, complications, residual shunt, changes of pulmonary artery pressure before and after operation, and its efficacy and safety were evaluated by 3-12 months follow-up.
Methods: Sixty children aged 1 to 18 years who underwent PDA occlusion in the Department of Pediatric Cardiology of Shandong Provincial Hospital from January 1, 2009 to December 31, 2011 were enrolled according to certain inclusion and exclusion criteria. According to the principle of ramming 2-4 mm in the narrowest diameter of the PDA, the occluder was selected using Amplatzer mushroom umbrella-shaped PDA occluder made by AGA Company of America or domestic mushroom umbrella-shaped PDA occluder. Intervention was carried out strictly according to the requirements of interventional therapy. Antibiotics were used to prevent infection 48 hours after the operation. Echocardiogram and electrocardiogram were followed up at 6 and 12 months to observe occluder morphology, residual shunt, changes of pulmonary artery pressure and complications.
Results: All the 60 cases had completed the occlusion operation. Most of the patients had a significant decrease of pressure immediately, and the pressure dropped by more than 50% during the operation. The pressure did not rise during the observation of 20 minutes. The mean values of PAMP and AP were 69.4+24.5mmHg, 45.3+14.2mmHg, 94.5+10.3mmHg, 32.6+8.2mmHg, 29.8+8.2mmHg, 98.8+6.2mmHg, respectively. There was no significant difference between preoperative and postoperative PASP and PAMP (T = 10.945, P = 0.01), (T = 12.603, P = 0.01). The mean values of PASP and PAMP were significantly lower than those before and after surgery (P = 0.01). There was no significant difference in the mean value of arterial oxygen saturation (P 0.05) and academic significance (T = 12.640, P = 0.12). VEDV decreased from 114.7 (+ 38.9) to 65.3 (+ 27.1 ml) (P 0.01), left ventricular end systolic volume (LVESV) from 31.7 (+ 12.8 m1) to 25.2 (+ 10.9 ml) (P 0.05), left ventricular stroke volume (LVSV) from 83.6 (+ 29.4 ml) to 53.1 (+ 24.6 ml) (P 0.01), left ventricular ejection fraction (LVEF) from 68.1 (+ 2.6%) to 63.5 (+ 5.3%) and left ventricular short axis shortening (LVFS) from surgery. There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 3 months postoperatively (P 0.05). There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 6 months postoperatively (P 0.05). There were 2 cases with small residual shunt and 1 case with residual shunt. The residual shunt disappeared in 1 case after 1 month follow-up, and a small residual shunt still existed in 1 case after 12 months follow-up.
Conclusion: PDA combined with PAH patients with occluder treatment, the technical operation is simple, safe, high success rate, fewer complications, in strict control of the indications in the medium and long-term effect is accurate, safe.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R725.4
[Abstract]:Objective: Congenital Heart Disease (CHD) is the most common heart disease in children. The common types are PDA patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, etc. Since 1960s, PDA occluder has been the first to treat CHD. Since 1990s, with the continuous development and improvement of interventional instruments, interventional therapy has been carried out. The advantages of simple operation, safe and effective treatment, rapid recovery and so on are becoming increasingly prominent and widely used in the world. At present, there are more and more analysis on the efficacy of interventional therapy with occluder for various CHD, and more and more research on the interventional therapy of PDA combined with PAH is also increasing, but in some aspects of the study is not systematic, this study on the application of occluder in the treatment of PDA combined. PAH was analyzed in terms of success rate, complications, residual shunt, changes of pulmonary artery pressure before and after operation, and its efficacy and safety were evaluated by 3-12 months follow-up.
Methods: Sixty children aged 1 to 18 years who underwent PDA occlusion in the Department of Pediatric Cardiology of Shandong Provincial Hospital from January 1, 2009 to December 31, 2011 were enrolled according to certain inclusion and exclusion criteria. According to the principle of ramming 2-4 mm in the narrowest diameter of the PDA, the occluder was selected using Amplatzer mushroom umbrella-shaped PDA occluder made by AGA Company of America or domestic mushroom umbrella-shaped PDA occluder. Intervention was carried out strictly according to the requirements of interventional therapy. Antibiotics were used to prevent infection 48 hours after the operation. Echocardiogram and electrocardiogram were followed up at 6 and 12 months to observe occluder morphology, residual shunt, changes of pulmonary artery pressure and complications.
Results: All the 60 cases had completed the occlusion operation. Most of the patients had a significant decrease of pressure immediately, and the pressure dropped by more than 50% during the operation. The pressure did not rise during the observation of 20 minutes. The mean values of PAMP and AP were 69.4+24.5mmHg, 45.3+14.2mmHg, 94.5+10.3mmHg, 32.6+8.2mmHg, 29.8+8.2mmHg, 98.8+6.2mmHg, respectively. There was no significant difference between preoperative and postoperative PASP and PAMP (T = 10.945, P = 0.01), (T = 12.603, P = 0.01). The mean values of PASP and PAMP were significantly lower than those before and after surgery (P = 0.01). There was no significant difference in the mean value of arterial oxygen saturation (P 0.05) and academic significance (T = 12.640, P = 0.12). VEDV decreased from 114.7 (+ 38.9) to 65.3 (+ 27.1 ml) (P 0.01), left ventricular end systolic volume (LVESV) from 31.7 (+ 12.8 m1) to 25.2 (+ 10.9 ml) (P 0.05), left ventricular stroke volume (LVSV) from 83.6 (+ 29.4 ml) to 53.1 (+ 24.6 ml) (P 0.01), left ventricular ejection fraction (LVEF) from 68.1 (+ 2.6%) to 63.5 (+ 5.3%) and left ventricular short axis shortening (LVFS) from surgery. There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 3 months postoperatively (P 0.05). There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 6 months postoperatively (P 0.05). There were 2 cases with small residual shunt and 1 case with residual shunt. The residual shunt disappeared in 1 case after 1 month follow-up, and a small residual shunt still existed in 1 case after 12 months follow-up.
Conclusion: PDA combined with PAH patients with occluder treatment, the technical operation is simple, safe, high success rate, fewer complications, in strict control of the indications in the medium and long-term effect is accurate, safe.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R725.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 溫仁祝,林輝,何巍,彭青云,鄭陳光,羅玉華;214例動(dòng)脈導(dǎo)管未閉的外科治療[J];廣西醫(yī)科大學(xué)學(xué)報(bào);2000年06期
2 張偉華;戴海龍;尹小龍;賴x，
本文編號(hào)：2223415
本文鏈接：http://sikaile.net/yixuelunwen/eklw/2223415.html
最近更新
教材專著
