先天性室間隔缺損個(gè)體化介入治療與外科手術(shù)對(duì)比研究
發(fā)布時(shí)間：2018-10-24 06:58
【摘要】：室間隔缺損(ventricular septal defect,VSD)是最常見(jiàn)的左向右分流型心臟畸形,易形成肺動(dòng)脈高壓,甚至艾森曼格綜合征,導(dǎo)致心功能降低,引起患者反復(fù)的肺部感染,影響其生長(zhǎng)發(fā)育,嚴(yán)重者可導(dǎo)致心衰或猝死。目前其常用的手術(shù)方式為外科修補(bǔ)手術(shù)治療和經(jīng)導(dǎo)管介入封堵治療。前者較成熟,成功率高,但需開(kāi)胸、建立體外循環(huán),輸血等;后者發(fā)展雖較晚,且受器械大小及患者年齡的限制,但因手術(shù)創(chuàng)傷小,恢復(fù)快等優(yōu)勢(shì),逐漸成為國(guó)內(nèi)治療室間隔缺損的研究熱點(diǎn)和難點(diǎn),人們對(duì)其長(zhǎng)期安全性及有效性研究較少。本文通過(guò)對(duì)分別接受兩種手術(shù)方法進(jìn)行治療的患者進(jìn)行隨訪,對(duì)比觀察兩者的療效。研究納入2010年1月至2011年12月在空軍總醫(yī)院心臟中心住院并接受治療的膜周部室間隔缺損患者109例,按手術(shù)方式分為介入封堵組(61例)和外科修補(bǔ)組(48例)。對(duì)比兩組患者術(shù)前基本情況(性別、年齡、體重、室間隔缺損大小、有無(wú)合并膜部瘤等),術(shù)中、術(shù)后(兩組手術(shù)成功率、輸血量、住院時(shí)間、住院總費(fèi)用等)及患者并發(fā)癥的發(fā)生和轉(zhuǎn)歸情況。隨訪觀察兩組患者術(shù)前、術(shù)后1天、術(shù)后3年的心電圖和心臟彩超的變化,比較兩種手術(shù)方法對(duì)心功能,如射血分?jǐn)?shù)(EF)、短軸縮短率(FS),心電指標(biāo),如QT離散度(QTd)、矯正QT離散度(QTcd)、V1導(dǎo)聯(lián)終末電勢(shì)(ptfv1)、Macruz指數(shù)的影響。研究發(fā)現(xiàn)介入封堵和外科修補(bǔ)術(shù)前性別、年齡、體重、室間隔缺損大小、合并膜部瘤例數(shù)均無(wú)明顯差別;介入封堵和外科修補(bǔ)技術(shù)成功率分別為96.72%,100%;輸血量分別為0ml,(629.17±300.32)ml;住院時(shí)間分別為(6.11±1.82)天,(12.90±1.68)天;住院總費(fèi)用分別為(23973±2551)元,(20395±4357)元。介入封堵組住院時(shí)間較外科手術(shù)組明顯短,且不需要輸血,但外科手術(shù)總費(fèi)用相對(duì)較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后介入封堵組和外科修補(bǔ)組總并發(fā)癥發(fā)生率分別為22.95%,37.50%,兩組比較無(wú)明顯差異;其中新增心律失常發(fā)生率分別為8.20%,10.42%,主要心律失常有右束支傳導(dǎo)阻滯、室性期前收縮、房性期前收縮、交界性心律、短P-R間期等,兩組均無(wú)左束支傳導(dǎo)阻滯及三度房室傳導(dǎo)阻滯等嚴(yán)重心律失常的發(fā)生;新增瓣膜反流分別為6.56%,6.25%,主要為少量瓣膜反流,兩組均無(wú)嚴(yán)重瓣膜反流的發(fā)生;殘余分流發(fā)生率分別為3.28%,2.08%,均為微量-少量殘余分流;兩組比較新增心律失常發(fā)生率、瓣膜反流、殘余分流發(fā)生率均無(wú)統(tǒng)計(jì)學(xué)差異,且多數(shù)并發(fā)癥在隨訪期間逐漸恢復(fù)。介入封堵及外科修補(bǔ)心功能均較術(shù)前明顯改善,兩組比較無(wú)明顯差異(P0.05)。介入封堵及外科手術(shù)后心電圖QTd、QTcd、ptfv1、macruz值均較術(shù)前明顯縮短,兩組組間比較無(wú)顯著差異(P0.05)。個(gè)體化介入封堵治療膜周部VSD與外科修補(bǔ)相比,具有成功率高、并發(fā)癥少的特點(diǎn),且不需要輸血及開(kāi)胸,恢復(fù)快。其中長(zhǎng)期療效及對(duì)心功能、心電學(xué)指標(biāo)的改善情況與外科手術(shù)相當(dāng)。介入封堵具有長(zhǎng)期安全性及有效性,對(duì)于符合介入治療標(biāo)準(zhǔn)的先天性膜周部VSD患者,采用個(gè)體化介入封堵可作為有效治療方法之一。
[Abstract]:Ventricular septal defect (VSD) is the most common left-to-right shunt type cardiac malformation, which is easy to form pulmonary hypertension, or even Asenmann's syndrome, which leads to a decrease in cardiac function, which causes repeated pulmonary infection of the patient and affects its development. At present, the surgical method is used for the surgical repair of surgical repair and transcatheter closure of the catheter. The former is mature and mature, but needs to open chest, establish extracorporeal circulation, blood transfusion, etc. The development of the latter is relatively late and is limited by the size of the device and the age of the patient, but due to the advantages of small operation trauma, quick recovery and the like, the former gradually becomes the research hotspot and difficulty in the treatment of ventricular septal defect in China. There is little research on long-term safety and effectiveness of people. Through follow-up of the patients treated with two kinds of surgical methods, the effect of the two methods was compared. A total of 109 patients with ventricular septal defect were enrolled and treated at the heart center of the Air Force Hospital from January 2010 to December 2011, and were divided into two groups (61 cases) and surgical repair group (48 cases). To compare the basic condition (sex, age, body weight, ventricular septal defect size, presence or absence of combined membrane tumor, etc.) in the two groups, intraoperative, postoperative (two groups of surgical success rate, transfusion volume, hospital stay, total hospital total cost, etc.), and the occurrence and outcome of complications of the patients. The cardiac function, such as ejection fraction (EF), short axis shortening (FS), ECG index, such as QT dispersion (QTd), corrected QT dispersion (QTcd), were compared between two groups of patients before operation, 1 day after operation, 3-year post-operation electrocardiogram and cardiac color ultrasound. The effect of V1 on terminal potential (ptfv1) and Macruz index. The results showed that there was no significant difference between sex, age, body weight, ventricular septal defect and size of ventricular septal defect before interventional occlusion and surgical repair. The success rate of interventional occlusion and surgical repair was 96. 72% and 100% respectively, and the blood transfusion volume was 0ml, (629. 17, 300. 32) ml, respectively; The hospitalization time was (6. 11) 1. 82) days, (12. 90 days 1. 68) days; the total cost of hospitalization was (23973 65.2551) Yuan, (20395 1964357) Yuan. The hospitalization time of interventional occlusion group was shorter than that in the surgical group, and no blood transfusion was needed, but the total cost of surgery was relatively low and the difference was statistically significant (P0.05). The incidence of total complications in interventional occlusion group and surgical repair group were 22. 95%, 37. 50%, respectively. There was no significant difference between the two groups. Among them, the incidence of newly increased arrhythmia was 8. 20%, 10. 42% respectively. The main arrhythmia had right bundle branch conduction block, pre-chamber contraction and pre-stage contraction. At the junctional rhythm, short P-R interval and so on, there were no left bundle branch block in the two groups and the occurrence of severe arrhythmia, such as atrioventricular block, and the reverse flow of the new valve was 6.56% and 6.25% respectively. The incidence of residual shunt was 3.28% and 2.08%, both of which were trace-small amount of residual shunt. There was no statistical difference in the incidence of newly increased arrhythmia, reverse flow and residual shunt in the two groups, and most of the complications were gradually restored during follow-up. There was no significant difference between the two groups (P0.05). The values of QTd, QTcd, ptfv1 and macruz in interventional occlusion and post-surgical procedure were significantly shorter than those before operation (P <0.05). Compared with the surgical repair, the VSD and the surgical repair method of the individualized interventional occlusion treatment membrane week part have the characteristics of low toxicity and less complications, and no blood transfusion and chest opening can be needed, and the recovery is rapid. The long-term efficacy and improvement in cardiac function and cardiac electrical parameters were comparable to those of surgery. Interventional occlusion has long-term safety and effectiveness. For the patients with congenital membranous peripheral VSD conforming to the interventional therapy standard, individualized interventional occlusion can be used as one of the effective treatment methods.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.1
本文編號(hào)：2290653
[Abstract]:Ventricular septal defect (VSD) is the most common left-to-right shunt type cardiac malformation, which is easy to form pulmonary hypertension, or even Asenmann's syndrome, which leads to a decrease in cardiac function, which causes repeated pulmonary infection of the patient and affects its development. At present, the surgical method is used for the surgical repair of surgical repair and transcatheter closure of the catheter. The former is mature and mature, but needs to open chest, establish extracorporeal circulation, blood transfusion, etc. The development of the latter is relatively late and is limited by the size of the device and the age of the patient, but due to the advantages of small operation trauma, quick recovery and the like, the former gradually becomes the research hotspot and difficulty in the treatment of ventricular septal defect in China. There is little research on long-term safety and effectiveness of people. Through follow-up of the patients treated with two kinds of surgical methods, the effect of the two methods was compared. A total of 109 patients with ventricular septal defect were enrolled and treated at the heart center of the Air Force Hospital from January 2010 to December 2011, and were divided into two groups (61 cases) and surgical repair group (48 cases). To compare the basic condition (sex, age, body weight, ventricular septal defect size, presence or absence of combined membrane tumor, etc.) in the two groups, intraoperative, postoperative (two groups of surgical success rate, transfusion volume, hospital stay, total hospital total cost, etc.), and the occurrence and outcome of complications of the patients. The cardiac function, such as ejection fraction (EF), short axis shortening (FS), ECG index, such as QT dispersion (QTd), corrected QT dispersion (QTcd), were compared between two groups of patients before operation, 1 day after operation, 3-year post-operation electrocardiogram and cardiac color ultrasound. The effect of V1 on terminal potential (ptfv1) and Macruz index. The results showed that there was no significant difference between sex, age, body weight, ventricular septal defect and size of ventricular septal defect before interventional occlusion and surgical repair. The success rate of interventional occlusion and surgical repair was 96. 72% and 100% respectively, and the blood transfusion volume was 0ml, (629. 17, 300. 32) ml, respectively; The hospitalization time was (6. 11) 1. 82) days, (12. 90 days 1. 68) days; the total cost of hospitalization was (23973 65.2551) Yuan, (20395 1964357) Yuan. The hospitalization time of interventional occlusion group was shorter than that in the surgical group, and no blood transfusion was needed, but the total cost of surgery was relatively low and the difference was statistically significant (P0.05). The incidence of total complications in interventional occlusion group and surgical repair group were 22. 95%, 37. 50%, respectively. There was no significant difference between the two groups. Among them, the incidence of newly increased arrhythmia was 8. 20%, 10. 42% respectively. The main arrhythmia had right bundle branch conduction block, pre-chamber contraction and pre-stage contraction. At the junctional rhythm, short P-R interval and so on, there were no left bundle branch block in the two groups and the occurrence of severe arrhythmia, such as atrioventricular block, and the reverse flow of the new valve was 6.56% and 6.25% respectively. The incidence of residual shunt was 3.28% and 2.08%, both of which were trace-small amount of residual shunt. There was no statistical difference in the incidence of newly increased arrhythmia, reverse flow and residual shunt in the two groups, and most of the complications were gradually restored during follow-up. There was no significant difference between the two groups (P0.05). The values of QTd, QTcd, ptfv1 and macruz in interventional occlusion and post-surgical procedure were significantly shorter than those before operation (P <0.05). Compared with the surgical repair, the VSD and the surgical repair method of the individualized interventional occlusion treatment membrane week part have the characteristics of low toxicity and less complications, and no blood transfusion and chest opening can be needed, and the recovery is rapid. The long-term efficacy and improvement in cardiac function and cardiac electrical parameters were comparable to those of surgery. Interventional occlusion has long-term safety and effectiveness. For the patients with congenital membranous peripheral VSD conforming to the interventional therapy standard, individualized interventional occlusion can be used as one of the effective treatment methods.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.1
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