小儿室间隔缺损预后及转归的回顾性研究

发布时间：2018-04-26 19:14

本文选题：儿童 + 室间隔缺损　；参考：《吉林大学》2013年硕士论文

【摘要】：目的：对450例VSD患儿进行回顾性研究，探讨与小儿VSD自然愈合过程相关的影响因素，更好的了解VSD患儿的预后及转归情况。方法：选择2005年1月-2012年12月就诊于我院，且生后0-6个月在我院行CDE检查，诊断存在VSD的450例患儿，并对其进行调查，调查时间最少为1年，最多4年；根据最终调查结果，患儿按照VSD的自然发展过程分为愈合组和未愈组，其中愈合组为研究组，未愈组为对照组；有68例VSD患儿在随访过程中行手术或介入治疗，不能计入VSD自然愈合统计结果，故对VSD自然愈合相关影响因素进行统计学分析时，剔除这些病例。但这部分患儿的统计资料计入VSD患儿的预后及转归分析中。运用t检验的方法对愈合组与未愈组患儿0-6个月时VSD的直径、AOD、MPA、LAD、RVD、LVEDD及呼吸系统感染积分的均值±标准差进行组间比较；运用2检验的方法对以下因素进行统计学分析，包括：VSD合并其他先天性心脏疾病（ASD、PDA、PH等）、复杂型CHD伴VSD、PAVP、缺损部位（pmVSD、MVSD、干下型VSD、混合型VSD）、膜部瘤形成、C/T、DS患儿伴有VSD、VSD合并高胆红素血症、母孕后前3个月患儿父母嗜烟、嗜酒、服用药物、接触放射线等；通过t检验及2检验分析，筛选出15个与VSD自然愈合相关因素，，再应用二项分类Logistic对15个因素进行逐步回归分析。结果：患儿3岁内的VSD自然愈合率为87.35%，3岁以后VSD自然愈合的比率明显下降。应用独立样本t检验的方法对相关因素的平均值±标准差（x±s）进行两组间的比较，结果显示：两组间小型VSD、中型VSD、MPA、LAD、RVD、LVEDD、呼吸系统感染积分的组间比较差异有统计学意义；AOD、大型VSD，IVST的组间比较虽有差异，但均无统计学意义（p0.05）。应用2检验对相关因素进行两组间的比较，结果如下：VSD合并PDA、复杂CHD伴有VSD、PAVP1.05m/s、pmVSD、MVSD、VSD伴有膜部瘤形成、VSD患儿C/T正常者及VSD伴有贫血者，差异有统计学意义（p0.05）。而VSD伴有ASD、VSD合并PH、干下型VSD、混合型VSD、DS伴有VSD患儿、VSD合并高胆红素血症、父母在母孕后前3个月嗜烟、嗜酒、接触放射线及服用药物患儿的组间比较差异无统计学意义（p0.05）。将上述单因素分析有意义的15个变量引入二项分类Logistic回归模型，选入和剔除变量的显著性水平分别为0.05和0.10，最终筛选出9个变量：PDA、复杂CHD、PAVp、pmVSD、MVSD、小型VSD、膜部瘤的形成、C/T，感染积分。对行手术或介入治疗的68例VSD患儿的调查结果提示，术后6个月内发生残余分流的患儿1例，呼吸道感染2例治愈，21例心律失常患儿术后6个月时仅有1例房室传导阻滞存在，其余患儿恢复正常，故总体预后良好。调查过程中死亡的7例VSD患儿，均为复杂CHD伴有VSD，患儿早期即出现了较多的并发症，反复感染，最后死于心力衰竭和呼吸衰竭。结论：1.小型VSD、pmVSD、MVSD、膜部瘤的形成、心脏大小正常及PAVP1.05m/s，具备上述特点或大部分特点的VSD患儿，缺损预后及转归良好，在患儿心功能良好，生长发育尚可的情况下，可暂缓手术或介入治疗，定期复查CDE至学龄期。2.合并PDA、复杂型CHD伴有VSD、干下型VSD、大型VSD、DS伴有VSD患儿及呼吸道感染情况重，VSD预后及转归较差，应尽早手术治疗。3.母孕后前3个月患儿父母嗜烟、嗜酒、接触放射线、服用药物未发现与VSD自然愈合有关。4.本文调查结果提示VSD手术或介入治疗总体预后良好。
[Abstract]:Objective: a retrospective study of 450 children with VSD was carried out to explore the factors related to the natural healing process of VSD in children and to better understand the prognosis and prognosis of children with VSD.
Methods: in December -2012 January 2005, in our hospital in December, and 0-6 months after birth in our hospital, 450 cases of VSD were diagnosed and investigated. The investigation time was at least 1 years, and the maximum was 4 years. According to the final survey results, the children were divided into the healing group and the non healing group according to the natural development process of VSD. The healing group was studied. In the group, the non healing group was the control group; 68 cases of VSD children were operated or intervened during the follow-up process, and the statistical results of VSD natural healing could not be counted. Therefore, when the related factors of natural healing of VSD were statistically analyzed, these cases were eliminated. But the statistical data of this part of the children were included in the prognosis and outcome analysis of the children of VSD. The use of T The method of test was used to compare the VSD diameter, AOD, MPA, LAD, RVD, LVEDD and the mean standard deviation of the respiratory system infection score at 0-6 months in the healing group and the non healing group. The following factors were statistically analyzed with the method of 2 test, including the combination of VSD with other congenital heart diseases (ASD, PDA, PH, etc.), and the complex CHD companion VSD. AVP, the defect site (pmVSD, MVSD, VSD, mixed VSD), membrane tumor formation, C/T, DS children with VSD, VSD combined with hyperbilirubinemia, the first 3 months after mother pregnancy, parents smoking, drinking, taking drugs, exposure to radiation and so on; through t test and 2 test analysis, select 15 related factors of VSD natural healing, and then apply two classification Log. A stepwise regression analysis of 15 factors was carried out by istic.
Results: the natural healing rate of VSD within 3 years of age was 87.35%, and the ratio of natural healing of VSD decreased significantly after 3 years of age. The mean value + standard deviation (x + s) of independent sample t test was compared between the two groups. The results showed that the two groups were small VSD, medium VSD, MPA, LAD, RVD, LVEDD, between groups of respiratory system infection. The difference was statistically significant, although there were differences in AOD, large VSD and IVST, but there was no statistical significance (P0.05). The results were as follows: VSD combined with PDA, complex CHD with VSD, PAVP1.05m/s, pmVSD, MVSD, VSD accompanied by the formation of membrane tumor. The difference was statistically significant (P0.05), while VSD was accompanied by ASD, VSD combined with PH, VSD, mixed VSD, DS with VSD, VSD combined with hyperbilirubinemia, parents were smoking in the first 3 months after mother pregnancy, alcohol, exposure to radiation and children taking drugs were not statistically significant (P0.05). The above single factor analysis was 15. Two classification Logistic regression models were introduced. The significant levels of selection and elimination were 0.05 and 0.10, and 9 variables were selected: PDA, complex CHD, PAVp, pmVSD, MVSD, small VSD, membranous tumor formation, C/T, infection integral. The results of 68 cases of VSD in 68 cases of operation or interventional therapy were found within 6 months after operation. 1 children with residual shunt, 2 cases of respiratory infection and 21 cases of arrhythmia in 6 months after operation, only 1 cases of atrioventricular block existed, and the rest of the children recovered to normal, so the overall prognosis was good. 7 cases of VSD children died in the investigation were complex CHD accompanied by VSD. The later died of heart failure and respiratory failure.
Conclusion: 1. small VSD, pmVSD, MVSD, membrane tumor formation, normal heart size and PAVP1.05m/s, with the above characteristics or most of the characteristics of children with VSD, the prognosis and prognosis are good. Under the condition of good heart function and the growth and development of children, the operation or interventional therapy can be postponed, and CDE to the school age.2. with PDA, complex CH D with VSD, lower VSD, large VSD, DS with VSD children and respiratory infection, VSD prognosis and poor prognosis, should be performed as early as possible for the first 3 months after.3. mother pregnancy, parents' smoking, alcoholism, exposure to radiation, and medication not found to be associated with VSD natural healing.4.: the findings suggest VSD or interventional therapy overall prognosis Good.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4

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