本文選題：先天性心臟病 + 房間隔缺損�。� 參考：《桂林醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的探討經(jīng)胸超聲心動(dòng)圖引導(dǎo)下應(yīng)用國產(chǎn)封堵器外科微創(chuàng)封堵治療先天性心臟病的可行性與安全性,探索其對(duì)心肌重構(gòu)及心功能的影響。方法2012年9月至2014年11月期間在我院診治的31例先天性心臟病患者,其中男性12例,女性19例,年齡1歲～66歲(平均15.2±17.7歲)。所有患者術(shù)前均經(jīng)常規(guī)體格檢查、心電圖、X線、TTE多切面(四腔心切面、左室長軸切面及劍突下雙心房切面)確診為先天性心臟病,其中單純性VSD10例,直徑3-8mm(平均5.4±1.35mm),單純性ASD21例,直徑5-32mm(平均11.4±5.3mm)�；颊呓�(jīng)胸部小切口開胸,非體外循環(huán)下在TTE引導(dǎo)下將封堵器固定于缺損位置,確保無殘余分流及瓣膜功能障礙后釋放封堵器。術(shù)后予以腸溶阿司匹林或潘生丁口服抗凝3個(gè)月。比較所有患者封堵術(shù)前、術(shù)后3個(gè)月左室內(nèi)徑(LV)、左房內(nèi)徑(LA)、右房內(nèi)徑(RA)和右室內(nèi)徑(RV)大小及左室射血分?jǐn)?shù)(EF)變化。結(jié)果經(jīng)胸超聲心動(dòng)圖引導(dǎo)下,封堵術(shù)后3月,10例VSD患者術(shù)前術(shù)后心臟大小對(duì)比,LA由(31.87±6.91)mm降至(27.13±7.81)mmm(P0.05),LV由(33.98±7.43)mm降至(29.02±6.63：mm(P0.05),RV由(20.11±4.28)mm升至(22.97±3.65)mm(P0.05)EF(%)由(59.11±4.23)升至(62.14±3.57) (P0.05)。21例ASD患者術(shù)中封堵失敗2例,19例ASD患者LV較術(shù)前相比,RA由(36.62±3.91)mm降至(32.92±4.57)mm(P0.05),RV由(21.41±2.39)mm降至(18.19±3.62)mm(P0.05),LV由(35.11±3.86)mm升至(39.15±6.52)mm(P0.05),EF(%)由(59.72±8.17)升至(65.64±7.89) (P0.05)。術(shù)后有4人出現(xiàn)輕度二尖瓣反流,跟蹤隨訪1～6個(gè)月,1例房間隔缺損出現(xiàn)殘余分流(直徑3.5mm),其余所有患者未出現(xiàn)瓣膜反流,未出現(xiàn)殘余分流、心律失常、房室傳導(dǎo)阻滯、血栓、氣胸和封堵器移位等相關(guān)并發(fā)癥。結(jié)論經(jīng)胸超聲可多切面監(jiān)測封堵過程,為先天性心臟病的微創(chuàng)封堵提供了一種新的引導(dǎo)方法和思路,為臨床治療提供更多的選擇。經(jīng)胸超聲引導(dǎo)下外科微創(chuàng)封堵治療先天性心臟病安全、可靠,成功率高。經(jīng)胸小切口微創(chuàng)封堵治療先天性心臟病能有效逆轉(zhuǎn)心肌重構(gòu),提高心功能。
[Abstract]:Objective to investigate the feasibility and safety of transthoracic echocardiographic guided minimally invasive occlusion for congenital heart disease (CHD), and to explore the effects of transthoracic echocardiography on myocardial remodeling and cardiac function. Methods from September 2012 to November 2014, 31 patients with congenital heart disease, including 12 males and 19 females, aged from 1 to 66 years (mean 15.2 鹵17.7 years), were treated in our hospital. All the patients were diagnosed as congenital heart disease by routine physical examination before operation. The patients were diagnosed as congenital heart disease by electrocardiogram X ray TTE multi-section (four chamber view, left ventricular long axis section and double atrium section of the left ventricular process). The diameter of simple VSD10 was 3. 8 mm (mean 5.4 鹵1. 35 mm), and simple ASD21 was found in 3 8 mm (mean 5. 4 鹵1. 35 mm). The diameter was 5-32 mm (mean 11.4 鹵5.3 mm). The occluder was fixed in the defect position under the guidance of TTE without cardiopulmonary bypass to ensure the release of occluder after no residual shunt and valve dysfunction. Postoperative enteric aspirin or dipyridamole oral anticoagulant for 3 months. The changes of left ventricular diameter (LVN), left atrial diameter (LAA), right atrial diameter (RV), right ventricular diameter (RV) and left ventricular ejection fraction (EF) were compared in all patients before and 3 months after occlusion. Results under the guidance of transthoracic echocardiography, Comparison of cardiac size in 10 VSD patients before and after closure from 31.87 鹵6.91)mm to 27.13 鹵7.81mm 7.43)mm from 33.98 鹵7.43)mm to 29.02 鹵6.63mmP0.05RV from 20.11 鹵4.28)mm to 22.97 鹵3.65mmP0.05EFV) from 59.11 鹵4.23 to 62.14 鹵3.57). The RV decreased from 21.41 鹵2.39)mm to 18.19 鹵3.62 鹵3.62 2.39)mm from 35.11 鹵3.86)mm to 39.15 鹵6.52 鹵6.5mm / L from 59.72 鹵8.17 to 65.64 鹵7.89). There were 4 patients with mild mitral regurgitation after operation. 1 case with atrial septal defect (3. 5 mm in diameter) was followed up for 1 ~ 6 months. No valve regurgitation, no residual shunt, arrhythmia, atrioventricular block, thrombus were found in all other patients. Pneumothorax and occluder displacement and other related complications. Conclusion Transthoracic ultrasound can monitor the occlusion process on multiple sections, which provides a new guiding method and train of thought for minimally invasive occlusion of congenital heart disease, and provides more choices for clinical treatment. Transthoracic ultrasound guided minimally invasive closure of congenital heart disease is safe, reliable and successful. Minimally invasive transthoracic closure can effectively reverse myocardial remodeling and improve cardiac function.
【學(xué)位授予單位】：桂林醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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