介入治療繼發(fā)孔型房間隔缺損直徑與所用封堵傘關(guān)系的研究
發(fā)布時(shí)間：2018-09-11 12:55
【摘要】：研究目的： 通過分析已行經(jīng)導(dǎo)管繼發(fā)孔型房間隔缺損(ASD)封堵術(shù)患者的相關(guān)資料,探討經(jīng)胸超聲心動(dòng)圖(TTE)測(cè)量繼發(fā)孔型房間隔缺損直徑與所用封堵傘放置前后傘腰直徑的關(guān)系,以助經(jīng)導(dǎo)管房間隔缺損封堵術(shù)中封堵傘大小的選擇。 研究方法： 第一部分：在山東省立醫(yī)院小兒心臟科行經(jīng)導(dǎo)管繼發(fā)孔型房間隔缺損封堵術(shù)且資料完整的患者共205例,所有患者均行TTE測(cè)量ASD直徑。將205例患者,按照ASD最大直徑的不同,分為三組：A組(5mmASD直徑12mm)65例、B組(12mmASD直徑20mm)76例,C組(ASD直徑≥20mm)64例。對(duì)經(jīng)評(píng)價(jià)判斷手術(shù)成功的患者相關(guān)資料進(jìn)行統(tǒng)計(jì)分析；連續(xù)變量資料采用方差分析,分類變量資料采用卡方檢驗(yàn)或Fisher確切概率法進(jìn)行統(tǒng)計(jì)分析,對(duì)比研究不同組中TTE測(cè)量ASD直徑與所用封堵傘傘腰之間的關(guān)系。 第二部分：在山東省立醫(yī)院小兒心臟科成功行經(jīng)導(dǎo)管繼發(fā)孔型房間隔缺損(ASD)封堵術(shù)且臨床資料與影像學(xué)資料均完整的患者144例,采用導(dǎo)管校準(zhǔn)法測(cè)量放置后封堵傘傘腰直徑,采用線性相關(guān)及線性回歸分析,探討TTE測(cè)量ASD直徑與所用封堵傘放置后傘腰關(guān)系。 結(jié)果： 1、(1)205例患者中193例手術(shù)成功,手術(shù)成功率為94.1%。其中手術(shù)成功患者A組65例、B組73例、C組55例,各組手術(shù)成功率分別為100%、96.1%、85.9%。 (2)ASD直徑在A組、B組、C組分別為8.89±1.86mm、15.16±2.06mm、24.69±4.01mm,ASD直徑在任意兩組之間P值均0.0001；所用封堵傘傘腰直徑分別為10.73±2.31mim、18.38±3.60mm、28.84±4.80mm,所用封堵傘傘腰直徑在任意兩組之間P值均0.0001。 (3)對(duì)A組、B組、C組所用封堵傘放置前傘腰直徑與ASD直徑進(jìn)行相關(guān)性檢驗(yàn),其相關(guān)系數(shù)分別為0.750、0.746、0.698,其P值均0.0001；所用封堵傘放置前傘腰直徑與TTE測(cè)量ASD直徑差值A(chǔ)組為1.87±1.49mm、B組為3.33±2.32mm、C組為4.52±3.19mm,此差值在A組與B組、A組與C組之間P值均小于0.0001,在B組與C組之間P值=0.033。所用封堵傘放置前傘腰直徑與ASD直徑差值的95%可信區(qū)間A組1.50～2.24mm、B組2.79～3.88mm、C組3.66～5.38mm。所用封堵傘放置前傘腰直徑與ASD直徑差值的90百分位數(shù)A組為4.0mm、B組為7.0mm、C組為10.0mm。 2、(1)144例患者TTE測(cè)量ASD直徑平均值為15.46±6.65mm,所用封堵傘放置前傘腰直徑平均值為18.36+7.83mm,所用封堵傘放置后傘腰直徑平均值為15.44±6.63mm。 (2)TTE測(cè)量ASD直徑與所用封堵傘放置后傘腰直徑進(jìn)行比較,其相關(guān)系數(shù)為0.936,P0.0001,具有統(tǒng)計(jì)學(xué)意義。將TTE測(cè)量ASD直徑與所用封堵傘放置后傘腰直徑建立直線回歸方程,則所用封堵傘放置后傘腰直徑=0.932×TTE測(cè)量ASD直徑+1.030。 (3)對(duì)TTE測(cè)量ASD直徑與所用封堵傘放置前傘腰直徑進(jìn)行相關(guān)性檢驗(yàn),其相關(guān)系數(shù)為0.948,P0.0001,具有統(tǒng)計(jì)學(xué)意義；將TTE測(cè)量ASD直徑與所用封堵傘放置前傘腰直徑建立直線回歸方程,則所用封堵傘放置前傘腰直徑=1.116×TTE測(cè)量ASD直徑+1.110。 結(jié)論： 1、對(duì)于單純性繼發(fā)孔型房間隔缺損,經(jīng)導(dǎo)管房間隔缺損介入治療效果好；當(dāng)ASD直徑20mm時(shí),手術(shù)成功率較高;當(dāng)ASD直徑≥20mm時(shí),發(fā)生封堵傘脫落、移位及術(shù)后殘余分流等并發(fā)癥可能性增大。 2、對(duì)于小的ASD,所用封堵傘傘腰直徑與TTE測(cè)量ASD直徑差值較�。寒�(dāng)缺損直徑小于12mm時(shí),所選用封堵傘傘腰直徑比ASD直徑大0-4mm；當(dāng)缺損直徑≥12mm、但20mm時(shí),所選用封堵傘傘腰直徑比ASD直徑大1-7mm;而對(duì)于較大缺損,所用封堵傘傘腰直徑與TTE測(cè)量ASD直徑差值較大,當(dāng)ASD直徑≥20mm時(shí),所選用封堵傘傘腰直徑比ASD直徑大2～10mm。 3、經(jīng)胸超聲心動(dòng)圖(TTE)能夠準(zhǔn)確測(cè)量房間隔缺損直徑,并且作為一種無創(chuàng)性影像學(xué)檢查方法,在經(jīng)導(dǎo)管房間隔缺損的介入治療中具有重要的指導(dǎo)意義。 4、TTE測(cè)量ASD直徑與所用封堵傘放置后傘腰直徑存在相關(guān)性,建立直線回歸方程為所用封堵傘放置后傘腰直徑=0.932×TTE測(cè)量ASD直徑+1.030。 5、TTE測(cè)量ASD直徑與所用封堵傘放置前傘腰直徑建立回歸方程為所用封堵傘放置前傘腰直徑=1.116xTTE測(cè)量ASD直徑+1.110。
[Abstract]:Research purposes:
To investigate the relationship between the diameter of secundum atrial septal defect (ASD) measured by transthoracic echocardiography (TTE) and the lumbar umbrella diameter before and after placement of the occluder umbrella, and to help the selection of the size of the occluder in transcatheter ASD occlusion.
Research methods:
The first part: 205 cases of ASD were performed transcatheter closure of secundum atrial septal defect in the Department of Pediatric Cardiology, Shandong Provincial Hospital. All patients were measured ASD diameter by TTE. 205 cases were divided into three groups according to the maximum diameter of ASD: 65 cases in group A (5 mm ASD diameter 12 mm), 76 cases in group B (12 mm ASD diameter 20 mm), and 76 cases in group C (ASD diameter 20 mm). Sixty-four patients with diameter (> 20 mm) were analyzed statistically. The data of continuous variables were analyzed by ANOVA, and the data of classified variables were analyzed by Chi-square test or Fisher exact probability method.
The second part: 144 cases of ASD were successfully treated by transcatheter closure in the Department of Pediatric Cardiology of Shandong Provincial Hospital. The diameter of umbrella waist was measured by catheter calibration method. The linear correlation and linear regression analysis were used to explore the relationship between TTE and ASD diameter. The relationship between the umbrella and the waist after the umbrella is placed.
Result:
1. (1) Among 205 cases, 193 cases were successfully operated, the success rate was 94.1%. Among them, 65 cases in group A, 73 cases in group B and 55 cases in group C were successfully operated. The success rates of each group were 100%, 96.1% and 85.9% respectively.
(2) The diameter of ASD in group A, group B, group C were 8.89 (+ 1.86 mm), 15.16 (+ 2.06 mm), 24.69 (+ 4.01 mm), and the diameter of ASD was 0.0001 between any two groups; the lumbar diameter of the occluding umbrella used was 10.73 (+ 2.31 mim), 18.38 (+ 3.60 mm), 28.84 (+ 4.80 mm), and the lumbar diameter of the occluding umbrella used was 0.0001.
(3) The correlation between the lumbar diameter and the diameter of ASD in group A, group B and group C was examined, and the correlation coefficients were 0.750, 0.746 and 0.698, respectively, with P values of 0.0001. The difference between the lumbar diameter and the diameter of ASD measured by TTE in group A and group B was 1.87 (+ 1.49mm), 3.33 (+ 2.32mm) and 4.52 (+ 3.19mm) respectively. The P value between group B and group C was less than 0.0001. The P value between group B and group C was 0.033. The 95% confidence interval of the difference between the lumbar diameter and the diameter of ASD was 1.50-2.24 mm in group A, 2.79-3.88 mm in group B, 3.66-5.38 mm in group C. The difference between the lumbar diameter and the diameter of ASD was 4.0 mm in group A, 7.0 mm in group B, and 10.0 mm in group C. .0mm.
2. (1) The mean diameter of ASD measured by TTE in 144 patients was 15.46 (+ 6.65 mm). The mean diameter of lumbar umbrella was 18.36 + 7.83 mm. The average diameter of lumbar umbrella was 15.44 (+ 6.63 mm) after placement of the occluding umbrella.
(2) The correlation coefficient of ASD diameter measured by TTE was 0.936, P 0.0001, which was statistically significant. The linear regression equation was established between ASD diameter measured by TTE and lumbar diameter measured by using plugging umbrella. The lumbar diameter measured by using plugging umbrella was 0.932 *TTE and ASD diameter + 1.030.
(3) The correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella was tested, and the correlation coefficient was 0.948, P 0.0001, which was statistically significant; the linear regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella, and the lumbar diameter measured by the plugging umbrella = 1.116 *TTE and the ASD diameter + 1.110.
Conclusion:
1. For simple secundum atrial septal defect, transcatheter atrial septal defect interventional therapy is effective; when the diameter of ASD is 20 mm, the surgical success rate is higher; when the diameter of ASD is more than 20 mm, occluding umbrella shedding, displacement and residual shunt after operation are more likely to occur.
2. For small ASD, the difference between the lumbar diameter of occluding umbrella and that of ASD measured by TTE is small: when the defect diameter is less than 12 mm, the lumbar diameter of occluding umbrella is 0-4 mm larger than that of ASD; when the defect diameter is more than 12 mm, but 20 mm, the lumbar diameter of occluding umbrella is 1-7 mm larger than that of ASD; for larger defect, the lumbar diameter of occluding umbrella is used. When the diameter of ASD is more than 20 mm, the diameter of umbrella waist is 2-10 mm larger than that of ASD.
3. Transthoracic echocardiography (TTE) can accurately measure the diameter of atrial septal defect, and as a non-invasive imaging method, it has important guiding significance in the interventional treatment of transcatheter atrial septal defect.
4. There is a correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella after placement of the plugging umbrella. A linear regression equation is established to measure the lumbar diameter of the umbrella after placement of the plugging umbrella = 0.932 * TTE and the lumbar diameter of the umbrella + 1.030.
5. The regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the front umbrella placed with the plugging umbrella. The lumbar diameter of the front umbrella placed with the plugging umbrella = 1.116xTTE was used to measure the ASD diameter + 1.110.
【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
本文編號(hào)：2236745
[Abstract]:Research purposes:
To investigate the relationship between the diameter of secundum atrial septal defect (ASD) measured by transthoracic echocardiography (TTE) and the lumbar umbrella diameter before and after placement of the occluder umbrella, and to help the selection of the size of the occluder in transcatheter ASD occlusion.
Research methods:
The first part: 205 cases of ASD were performed transcatheter closure of secundum atrial septal defect in the Department of Pediatric Cardiology, Shandong Provincial Hospital. All patients were measured ASD diameter by TTE. 205 cases were divided into three groups according to the maximum diameter of ASD: 65 cases in group A (5 mm ASD diameter 12 mm), 76 cases in group B (12 mm ASD diameter 20 mm), and 76 cases in group C (ASD diameter 20 mm). Sixty-four patients with diameter (> 20 mm) were analyzed statistically. The data of continuous variables were analyzed by ANOVA, and the data of classified variables were analyzed by Chi-square test or Fisher exact probability method.
The second part: 144 cases of ASD were successfully treated by transcatheter closure in the Department of Pediatric Cardiology of Shandong Provincial Hospital. The diameter of umbrella waist was measured by catheter calibration method. The linear correlation and linear regression analysis were used to explore the relationship between TTE and ASD diameter. The relationship between the umbrella and the waist after the umbrella is placed.
Result:
1. (1) Among 205 cases, 193 cases were successfully operated, the success rate was 94.1%. Among them, 65 cases in group A, 73 cases in group B and 55 cases in group C were successfully operated. The success rates of each group were 100%, 96.1% and 85.9% respectively.
(2) The diameter of ASD in group A, group B, group C were 8.89 (+ 1.86 mm), 15.16 (+ 2.06 mm), 24.69 (+ 4.01 mm), and the diameter of ASD was 0.0001 between any two groups; the lumbar diameter of the occluding umbrella used was 10.73 (+ 2.31 mim), 18.38 (+ 3.60 mm), 28.84 (+ 4.80 mm), and the lumbar diameter of the occluding umbrella used was 0.0001.
(3) The correlation between the lumbar diameter and the diameter of ASD in group A, group B and group C was examined, and the correlation coefficients were 0.750, 0.746 and 0.698, respectively, with P values of 0.0001. The difference between the lumbar diameter and the diameter of ASD measured by TTE in group A and group B was 1.87 (+ 1.49mm), 3.33 (+ 2.32mm) and 4.52 (+ 3.19mm) respectively. The P value between group B and group C was less than 0.0001. The P value between group B and group C was 0.033. The 95% confidence interval of the difference between the lumbar diameter and the diameter of ASD was 1.50-2.24 mm in group A, 2.79-3.88 mm in group B, 3.66-5.38 mm in group C. The difference between the lumbar diameter and the diameter of ASD was 4.0 mm in group A, 7.0 mm in group B, and 10.0 mm in group C. .0mm.
2. (1) The mean diameter of ASD measured by TTE in 144 patients was 15.46 (+ 6.65 mm). The mean diameter of lumbar umbrella was 18.36 + 7.83 mm. The average diameter of lumbar umbrella was 15.44 (+ 6.63 mm) after placement of the occluding umbrella.
(2) The correlation coefficient of ASD diameter measured by TTE was 0.936, P 0.0001, which was statistically significant. The linear regression equation was established between ASD diameter measured by TTE and lumbar diameter measured by using plugging umbrella. The lumbar diameter measured by using plugging umbrella was 0.932 *TTE and ASD diameter + 1.030.
(3) The correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella was tested, and the correlation coefficient was 0.948, P 0.0001, which was statistically significant; the linear regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella, and the lumbar diameter measured by the plugging umbrella = 1.116 *TTE and the ASD diameter + 1.110.
Conclusion:
1. For simple secundum atrial septal defect, transcatheter atrial septal defect interventional therapy is effective; when the diameter of ASD is 20 mm, the surgical success rate is higher; when the diameter of ASD is more than 20 mm, occluding umbrella shedding, displacement and residual shunt after operation are more likely to occur.
2. For small ASD, the difference between the lumbar diameter of occluding umbrella and that of ASD measured by TTE is small: when the defect diameter is less than 12 mm, the lumbar diameter of occluding umbrella is 0-4 mm larger than that of ASD; when the defect diameter is more than 12 mm, but 20 mm, the lumbar diameter of occluding umbrella is 1-7 mm larger than that of ASD; for larger defect, the lumbar diameter of occluding umbrella is used. When the diameter of ASD is more than 20 mm, the diameter of umbrella waist is 2-10 mm larger than that of ASD.
3. Transthoracic echocardiography (TTE) can accurately measure the diameter of atrial septal defect, and as a non-invasive imaging method, it has important guiding significance in the interventional treatment of transcatheter atrial septal defect.
4. There is a correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella after placement of the plugging umbrella. A linear regression equation is established to measure the lumbar diameter of the umbrella after placement of the plugging umbrella = 0.932 * TTE and the lumbar diameter of the umbrella + 1.030.
5. The regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the front umbrella placed with the plugging umbrella. The lumbar diameter of the front umbrella placed with the plugging umbrella = 1.116xTTE was used to measure the ASD diameter + 1.110.
【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 張玉順,李寰,張軍,賈國良,代政學(xué),王小燕;經(jīng)胸超聲心動(dòng)圖指導(dǎo)下Amplatzer封堵成人房間隔缺損[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2002年01期
2 黃國明;丁仲如;涂曉文;喬懷宇;王洪如;余艷麗;韓清萍;文萍;;巨大房間隔缺損介入封堵治療的可行性和安全性評(píng)價(jià)[J];國際心血管病雜志;2008年03期
3 朱鮮陽;;常見先天性心臟病介入治療中國專家共識(shí) 一、房間隔缺損介入治療[J];介入放射學(xué)雜志;2011年01期
4 魏盟,王春生,潘翠珍,王齊冰,金惠根,薛小培;經(jīng)胸超聲心動(dòng)圖下心導(dǎo)管法修補(bǔ)心房間隔缺損[J];臨床心血管病雜志;2001年07期
5 唐立;李華;牛銘;;經(jīng)食道三維超聲與經(jīng)胸超聲在診斷房間隔缺損中的應(yīng)用[J];中外醫(yī)療;2012年30期
6 王心;尚麗新;;先天性心臟病臨床特點(diǎn)及防治策略[J];人民軍醫(yī);2012年04期
7 張玉順,李寰,代政學(xué),張軍,李軍;42～46mm封堵器介入治療巨大房間隔缺損的療效及經(jīng)驗(yàn)[J];心臟雜志;2005年03期
8 馬翔,馬依彤;經(jīng)導(dǎo)管Amplatzer封堵裝置治療房間隔缺損的研究現(xiàn)狀與進(jìn)展[J];心血管病學(xué)進(jìn)展;2004年05期
9 戴玫;唐炯;;特殊類型房間隔缺損的介入治療進(jìn)展[J];心血管病學(xué)進(jìn)展;2009年03期
10 王毅;覃軍;;房間隔缺損封堵術(shù)后封堵器血栓形成及防治現(xiàn)狀[J];心血管病學(xué)進(jìn)展;2012年01期
，本文編號(hào)：2236745
本文鏈接：http://sikaile.net/yixuelunwen/eklw/2236745.html
最近更新
教材專著
