经皮球囊肺动脉瓣成形术治疗肺动脉瓣狭窄75例临床分析

发布时间：2018-07-06 20:29

本文选题：肺动脉瓣狭窄 + 经皮球囊肺动脉瓣成形术　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：分析经皮球囊肺动脉瓣成形术（PBPV）治疗单纯性肺动脉瓣狭窄(PS)的疗效，提高治愈率，减少并发症。方法：回顾性分析重庆医科大学附属儿童医院于2004年7月～2011年6月采用PBPV术治疗的75例PS患儿的临床资料，比较扩张前后肺动脉、右心室压力变化以及球囊的选择情况，术后并发症情况。结果：1.本组PS患者的年龄3岁51例，占总例数的68%，~3岁24例，占总例数的32%，男性43例（57%）、女性32例（43%），其比例约为1.3:1；轻度PS40例（53%），中度PS32例（43%），重度PS3例（4%）。 2.儿童PS常见的症状为多汗（23/75），吃奶中断或呛奶（10/75），活动后气促或是活动耐力低于同龄儿（14/75），重者出现蹲踞（1/75），影响生长发育，出现生长发育迟缓；患者常伴发上呼吸道感染（16/75）、肺炎（8/75）及腹泻病（1/75）等；体检发现心前区或胸骨左缘第2-3 肋间2-4级吹风样或喷射样杂音（75/75），并向腋下或颈部传导（14/75）,P2减弱（19/75），一部分伴有震颤（11/75）；患儿往往心前*本课题受国家十一五计划资助(2007BAI05B03)区无隆起（75/75）；中至重度PS常常可见紫绀（13/75）。 3.本组PS合并先天性心脏病如房间隔缺损（6/75）、动脉导管未闭（3/75），肺动脉狭窄（2/75）等；同时偶有伴发缺铁性贫血（1/75）及脑瘫（1/75）等。 4.PS患者典型的胸片表现为肺少血:肺血管纹理偏细或稀疏(40/75)，心影增大，特别是右室和右房扩大，心胸比增大（大于0.5）(26/75)；同时常常可见到肺动脉段隆起(24/75)；部分轻度中度的PS的胸片也可表现为无明显异常(26/75)。此外对于合并呼吸道感染的PS患儿也可表现为肺纹理增多(9/75)。 5.PS的心电图常见的表现为电轴右偏、右心室肥大（34/75）；合并心律失常，常见的有：窦性心律不齐（22/75），QT高值（6/75），ST段改变（3/75），T波改变（4/75）,不典型不完全性右束支传导阻滞（3/75）,低电压倾向（2/75），不完全性右束支传导阻滞（1/75），Ⅰ度房室传导阻滞（1/75），室性早搏（偶发）（1/75），u波改变（1/75），房室交界性心律（1/75），电轴左偏（1/75）。此外，也有相当一部分的PS心电图未见明显异常（20/75）。 PBPV术后患儿术后电轴右偏、右心室肥大较术前明显改善；Ⅰ度房室传导阻滞及室性早搏（偶发）则于术后消失；新出现了完全性右束支阻滞（1例）、QT延长（2例）及PR高值（3例），无严重心律失常出现。 6.本组75例PS术前右室收缩压为(70.24±23.54)mmHg(1mmHg=0.133kPa)，术后即刻心导管检测降为(34.75±9.12)mmHg(P0.01)；跨肺动脉瓣压力阶差（△P）术前为(49.41±22.57)mmHg，术后即刻心导管检测降为(11.33±7.25)mmHg(P0.01)；术后即刻心导管检测跨肺动脉瓣压力阶差25mmHg达94.67％。术后24小时经超声测定△P为(23.04±9.80)mmHg；术后1月、术后3月、术后6月及术后1年超声测定△P均较术后24小时明显下降；右室造影肺动脉瓣环直径为（13.76±3.18）mm，所选球囊大小为（16.70±3.68）mm；无严重并发症和死亡病例发生。 7.术后随访患儿多汗、吃奶中断或呛奶、活动后气促均较术前明显缓解，生长发育改善；体检发现心脏杂音明显减弱或消失. 结论：PBPV治疗儿童PS安全有效。严格掌握适应证，，规范操作，结合术前超声和右室造影判断肺动脉瓣环大小，选择合适大小球囊是介入成功的关键。对可疑PS患者早诊断、早治疗，对改善儿童生长发育及预后有重要意义。
[Abstract]:Objective: to analyze the efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) in the treatment of simple pulmonary valve stenosis (PS), improve the cure rate and reduce complications.
Methods: the clinical data of 75 children with PS in the Affiliated Children's Hospital of Medical University Of Chongqing from July 2004 to June 2011 were analyzed. The changes of pulmonary artery, right ventricular pressure, selection of balloon and postoperative complications were compared before and after the expansion of PBPV.
Results: 1. the age of 1. patients was 3 years old and 51 cases, accounting for 68% of the total number, 24 cases of ~3 years old, 32% of the total number, 43 men (57%) and 32 women (43%), with a proportion of about 1.3:1, mild PS40 (53%), moderate PS32 (43%), and severe PS3 cases (4%).
2. children's common symptoms of PS are perspiration (23/75), milk interruption or choking (10/75), after activity or activity endurance is lower than the same age (14/75), and the heavy crouching (1/75), affecting growth and development, growth retardation, patients often associated with upper respiratory infection (16/75),
Pneumonia (8/75) and diarrhoeal disease (1/75); physical examination found the precordial area or the left margin of sternum 2-3.
The 2-4 stage of the intercostal blower or spray like murmurs (75/75), conduction (14/75) to the underarm or neck (14/75), P2 weakened (19/75), and a part accompanied by tremor (11/75); children tend to be subject to the national 11th Five-Year program funded (2007BAI05B03) area without a bulge (75/75); moderate to severe PS is often seen in cyanosis (13/75).
3. PS combined with congenital heart disease such as atrial septal defect (6/75), patent ductus arteriosus (3/75), pulmonary artery stenosis (2/75), and occasionally accompanied by iron deficiency anemia (1/75) and cerebral palsy (1/75).
The typical chest radiographs of 4.PS patients were pulmonary less blood: the pulmonary vascular texture was thinner or thinner (40/75), the heart shadow increased, especially the right ventricle and right chamber enlargement, the heart ratio increased (more than 0.5) (26/75), and the pulmonary artery segment (24/75) was often seen; some mild moderate PS chest films could also show no obvious abnormality (26/75). In addition, the combination of the chest radiographs was also uncommon. Respiratory tract infection in children with PS can also be manifested as increased lung markings (9/75).
The common manifestations of 5.PS's electrocardiogram were right deviation of electric axis and right ventricular hypertrophy (34/75); combined arrhythmia, sinus arrhythmia (22/75), high value of QT (6/75), ST segment change (3/75), T wave change (4/75), atypical incomplete right bundle conduction retardation (3/75), low voltage tendency (2/75), incomplete right bundle branch block (1/75), I degree Atrioventricular block (1/75), ventricular premature beat (Ou Fa) (1/75), U wave change (1/75), atrioventricular junctional rhythm (1/75), left axis deviation (1/75).
In addition, a significant part of PS electrocardiogram showed no obvious abnormality (20/75).
The right ventricular hypertrophy and right ventricular hypertrophy after PBPV were obviously improved than that before operation, and I degree atrioventricular block and ventricular premature beat (Ou Fa) disappeared after operation; new complete right bundle branch block (1 cases), QT lengthening (2 cases) and PR high value (3 cases), no serious arrhythmia appeared.
6. the right ventricular systolic pressure was (70.24 + 23.54) mmHg (1mmHg=0.133kPa) before PS, and the immediate cardiac catheterization was reduced to (34.75 + 9.12) mmHg (P0.01) immediately after operation, and the pressure step difference (delta P) was (49.41 + 22.57) mmHg before operation. The immediate cardiac catheterization was reduced to (11.33 + 7.25) mmHg (P0.01) immediately after operation, and immediately after the operation, the cardiac catheterization was used to detect the cross pulmonary valve. The pressure order difference 25mmHg was (23.04 + 9.80) mmHg by ultrasonography 24 hours after the operation. In January, March after operation, in June and 1 years after operation, Delta P was significantly lower than that of 24 hours after operation; the diameter of pulmonary valvular ring in right ventricle was (13.76 + 3.18) mm and the size of the balloon was (16.70 + 3.68) mm, without serious complications and death. Case of death.
After 7., the children were followed up with hyperhidrosis, and the milk was interrupted or choked. After the activity, the growth and development were obviously relieved and the growth and development were improved, and the heart murmur was obviously weakened or disappeared.
Conclusion: PBPV is effective and effective in the treatment of children's PS. It is important to strictly master the indications, standardize the operation, judge the size of the pulmonary valvular ring with preoperative ultrasound and right ventriculography, and choose the right balloon for the success of the intervention. Early diagnosis and early treatment for suspected PS patients are of great significance to improve the growth and prognosis of children.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4

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