儿童房间隔缺损介入术前后凝血机能的变化和炎症反应的探讨

发布时间：2018-04-29 04:25

  本文选题：房间隔缺损 + 介入治疗　； 参考：《重庆医科大学》2012年硕士论文

【摘要】：目的探讨儿童房间隔缺损(atrial septal defect, ASD)封堵器植入前后凝血机能的变化趋势及ASD介入治疗的安全、有效性。 方法选取成功接受ASD介入封堵治疗的患者19例(女13例,男6例,平均年龄6.74±4.3岁),采用酶联免疫吸附法(enzyme linked immunosorbent assays, ELISA)检测患者介入封堵前、术后即刻、术后1日、术后30日、术后90日,血浆凝血酶原片段1+2(prothrombin fragment1+2, F1+2)、p-血小板球蛋白(β-thromboglobulin, β-TG)、血浆组织型纤溶酶原激活物(tissue-type plasminogen activator, t-PA)、D二聚体(D-dimer, D-D)水平,经胸超声心动图(tranthoracic echocardiography, TTE)检测是否存在残余分流、封堵器移位、封堵器血栓。 结果与封堵术前比较,F1+2、t-PA、D-D血浆浓度术后即刻明显升高,具有统计学意义(P0.05),术后1日较术前水平仍高,但差异无统计学意义(P0.05),术后30日基本恢复至术前水平；β-TG术后即刻明显升高且具有统计学意义(P0.05),术后1日基本恢复至术前水平；术后TTE随访中未发现有残余分流、封堵器移位、封堵器血栓形成。 结论儿童ASD介入封堵术后出现了凝血酶、纤溶系统的激活以及血小板的活化,短期内恢复至术前水平；介入治疗ASD安全、有效。 目的探讨儿童ASD封堵器植入前后炎症反应程度及相关因素。 方法选取成功接受ASD介入封堵治疗的19例ASD患儿(女13例,男6例,平均年龄6.7±4.3岁),ELISA法检测患者介入封堵前、术后即刻、术后1日、术后30日、术后90日血浆白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)浓度,金标法测定C反应蛋白(c-reactive protein, CRP)术前、术后即刻、术后1日血浆浓度,比较封堵前后不同时间点、封堵器大小、介入时间、封堵器类别、不同性别之间炎症标志物的变化。 结果与封堵前比较,患儿血浆IL-6、TNF-α浓度术后即刻升高(P0.05),术后30日有明显降低,仍高于术前但差异无统计学意义(P0.05),均于术后90日基本恢复至术前水平；CRP浓度无明显变化；ASD封堵器直径≥10mm组与10mm组、手术时间≥60min组与60min组、两不同公司封堵器之间、不同性别之间比较,各组IL-6、TNF-α和CRP水平差异均无统计学意义(P0.05)。 结论儿童ASD介入封堵患者体内出现一过性炎症反应,此炎症反应具有自限性；介入治疗ASD安全、有效。
[Abstract]:Objective to investigate the trend of coagulation before and after atrial septal occluder implantation in children with atrial septal defect (ASD) and the safety and efficacy of ASD interventional therapy. Methods A total of 19 patients (female 13, male 6, mean age 6.74 卤4.3 years old) who were successfully treated with ASD were selected. The patients were detected by enzyme linked immunosorbent assays, ELISA) immediately before, 1 day after operation and 30 days after the operation by enzyme-linked immunosorbent assay (Elisa). Plasma prothrombin fragment 1 2(prothrombin fragment1 2, 尾 -thromboglobulin (尾 -TGG), tissue plasminogen activator tissue type plasminogen activator (t-PAP) D-dimer, D-dimer (D-D) were detected by transthoracic echocardiography (TTEs) on the 90th day after operation, and the residual shunt was detected by transthoracic echocardiography. Occluder shift, occluder thrombus. Results compared with that before occlusion, plasma concentration of F12t PAG D-D increased significantly immediately after operation, and had statistical significance (P 0.05). The level of plasma was still higher on 1 day after operation than that before occlusion. However, the difference was not statistically significant (P 0.05) and recovered to the preoperative level 30 days after operation; 尾 -TG was significantly increased immediately after operation and had statistical significance (P 0.05), and recovered to the preoperative level on 1 day after operation. No residual shunt was found in postoperative TTE follow-up, and occluder displacement was found. Occluder thrombosis. Conclusion Thrombin, fibrinolytic system activation and platelet activation after interventional closure of ASD in children recovered to preoperative level in a short time, and interventional therapy for ASD was safe and effective. Objective to investigate the degree of inflammatory reaction and related factors before and after ASD occluder implantation in children. Methods A total of 19 patients (13 female, 6 male, mean age 6.7 卤4.3 years) with ASD received successful interventional closure of ASD were detected by Elisa before, immediately, 1 day, 30 days after the operation. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor- 伪 (TNF- 伪) were measured 90 days after operation. Plasma concentrations of C-reactive protein (CRP) were measured by gold standard method before, immediately after operation and 1 day after operation. The size of occluder and interventional time before and after occlusion were compared. Type of occluder, changes in inflammatory markers between genders. Results compared with that before occlusion, plasma IL-6 TNF- 伪 concentration increased immediately after operation and decreased significantly 30 days after operation. It was still higher than that before operation, but the difference was not statistically significant (P 0.05). There was no significant change in the concentration of CRP to the preoperative level 90 days after operation. The diameter of ASD occluder 鈮，

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