食道超声引导下经胸介入治疗室间隔缺损的临床研究

发布时间：2018-08-28 13:20

【摘要】：目的：通过食道超声引导经胸微创治疗室间隔缺损,实时监测VSD封堵前后心内血流动力学的变化,来确定该方法可行性及优越性,并对这个方法进行一定的临床研究。方法：选择我院在2012年3月-2012年7月间共50名VSD患儿,其中男性28例,女性22例,年龄11月-8岁,体重6～28kg。其中膜部VSD42例,肌部VSD5例,肺瓣下VSD3例。患儿行全身麻醉后,采用TEE引导室间隔缺损封堵器来封堵VSD。封堵前通过TEE再次观测VSD的位置及其与邻近结构的位置关系并记录,通过脉冲多普勒测量右上肺静脉血流频谱,记录S、D、A。封堵后再次测量右上肺静脉血流频谱,记录S、D、A。记录手术中放置封堵器的时间,出血量。记录术前及术后经TTE测量的传统心功能参数EF、FS、LVDD的值。结果： 50例患儿中有三例因术中TEE再次检查确认不适合封堵而放弃封堵,其余封堵全部成功。传统心功能参数EF、FS、LVDD在术前术后无显著性差异(P0.05),肺静脉血流频谱S、D、A在术前术后相比有显著差异(P0.05)。结论： TEE可以进一步对该类手术病人进行筛选,能够实时动态监测手术对心脏的影响,指导外科医师采取适当术式安全的完成手术,并能在术后即刻评价手术效果,在此类手术中具有较高应用价值。术中经TEE行肺静脉血流频谱检测,可以早期发现手术中心功能的变化,从而进一步提高手术的安全性。
[Abstract]:Objective: to determine the feasibility and superiority of transthoracic minimally invasive treatment of ventricular septal defect (VSD) by transesophageal ultrasound guidance and real-time monitoring of the changes of intracardiac hemodynamics before and after VSD occlusion. The clinical study of this method was carried out. Methods: a total of 50 children with VSD were selected from March 2012 to July 2012, including 28 males and 22 females, aged from November to 8, with a body weight of 6 ~ 28kg. Of them, there were VSD42 in membrane, VSD5 in muscle and VSD3 in subvalvular lung. After general anesthesia, TEE guided ventricular septal defect occluder was used to block VSD.. Before occlusion, the position of VSD and its relationship with adjacent structures were observed again by TEE, and the right superior pulmonary vein blood flow spectrum was measured by pulse Doppler. Right superior pulmonary vein blood flow spectrum was measured again after occlusion. Record the time when the occluder was placed and the amount of blood lost during the operation. The EF,FS,LVDD values of traditional cardiac function parameters measured by TTE before and after operation were recorded. Results: three of the 50 children gave up the occlusion because of the reexamination of TEE during operation, and the others were all successful. There was no significant difference in traditional cardiac function parameters before and after operation (P0.05), but there was significant difference in pulmonary venous blood flow spectrum (P0.05) before and after operation (P0.05). Conclusion: TEE can further screen the patients of this kind of operation, monitor the effect of operation on heart in real time and dynamically, instruct the surgeon to complete the operation safely, and evaluate the effect of operation immediately after operation. It has high application value in this kind of operation. Intraoperative pulmonary venous blood flow spectrum detection via TEE can detect the change of operation center function early, and further improve the safety of the operation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.1

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