超声监护下国产器材封堵房间隔缺损的心导管法与经胸小切口法对比分析

发布时间：2018-11-26 08:49

【摘要】：目的:评价超声心动图引导下采用国产器材在封堵房间隔缺损(atrial septal defect,ASD)时心导管法及经胸小切口法两种介入术式的安全性。方法:回顾性分析成功采用国产器材封堵ASD共1 080例,其中心导管法734例,经胸小切口法346例。心导管法术中是在导管室用大型数字减影血管造影机引导下,并结合经胸超声心动图(transthoracic echocardiography,TTE)监测整个封堵过程,以TTE评价疗效。经胸小切口法在手术室完全使用经食管超声心动图(transesophageal echocardiography,TEE)引导整个封堵过程,指导放置封堵器,并即刻评价疗效。结果:两种介入术式中用国产器材封堵ASD均能取得满意疗效,两种介入术式比较,缺损最长径大小差异无统计学意义(P0.05),ASD/房间隔长度、封堵器大小、封堵器大小与ASD最长径的差值差异均有统计学意义(均P0.05)。当ASD算术平均数30 mm时,两种介入术式封堵成功率均为100%;当ASD算术平均数≥30 mm时,经胸小切口法封堵成功率为100%,心导管法封堵成功率为50%。结论:国产器材封堵安全,成本低。对于同样大小的缺损,经胸小切口法选择的封堵器较小,更合适。当ASD算术平均数≥30 mm时,经胸小切口法成功率比心导管法大,心导管法失败者可转为经胸小切口法。
[Abstract]:Objective: to evaluate the safety of cardiac catheterization and transthoracic small incision during transcatheter closure of atrial septal defect (atrial septal defect,ASD) under echocardiographic guidance. Methods: 1 080 cases of ASD were successfully occluded with domestic equipment, including 734 cases with cardiac catheterization and 346 cases with transthoracic small incision. Under the guidance of large digital subtraction angiography machine and transthoracic echocardiography (transthoracic echocardiography,TTE), the whole occlusion process was monitored in cardiac catheterization. TTE was used to evaluate the effect of cardiac catheterization. Transthoracic transesophageal echocardiography (transesophageal echocardiography,TEE) was used to guide the whole occlusion process, to guide the placement of occluder, and to evaluate the curative effect immediately. Results: the ASD was occluded with domestic equipment in two interventional procedures. There was no significant difference in the longest diameter of defect between the two interventional procedures (P0.05), the atrial septal length of ASD/, the size of occluder, and the size of occluder were not significantly different between the two interventional procedures (P0.05). The difference between the size of occluder and the longest diameter of ASD was statistically significant (P0.05). When ASD arithmetic average was 30 mm, the success rate of two interventional procedures was 100, when ASD arithmetic average was more than 30 mm, the success rate of transthoracic small incision occlusion was 100 and that of cardiac catheterization was 50. Conclusion: domestic equipment is safe and low cost. For the same size defect, the transthoracic small incision occluder is smaller and more suitable. When the arithmetic average of ASD was more than 30 mm, the success rate of transthoracic small incision was higher than that of cardiac catheterization, and the failure of cardiac catheterization could be converted to transthoracic small incision.
【作者单位】：河北医科大学第一医院心脏超声科;香港大学深圳医院心血管内科;河北医科大学第一医院心血管外科;河北医科大学第一医院心血管内科;
【基金】：河北省医学科学研究重点课题(ZL20140061)~~
【分类号】：R540.45;R541.1

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