动脉导管未闭合并肺动脉高压封堵术后随访研究
发布时间：2018-09-05 06:04
【摘要】：目的：先天性心脏病(Congenital Heart Disease,CHD),是小儿最常见的心脏疾患。常见类型主要有动脉导管未闭(PDA patent ductus arteriosus)、房间隔缺损(ASD atrial septal defect)、室间隔缺损(VSD ventricular septal defect)、肺动脉瓣狭窄(PS pulmonary stenosis)等。以往需要外科治疗,即开胸手术。而且多需体外循环(CPB extracorporeal circulation)、全身麻醉、输血等,损伤较大,住院时间长,带来较多术后并发症。自20世纪60年代以来,PDA封堵器治疗CHD最先展开,90年代以来,随着介入器械的不断研发及改进,介入治疗操作简单、安全有效、恢复快等优点日益凸显出来,并在世界范围内广泛应用。目前,关于封堵器介入治疗多种CHD的疗效分析比较多,PDA合并PAH的介入治疗研究也日益增多,但在某些方面的研究还不系统,本研究就应用封堵器治疗PDA合并PAH,从成功率、并发症发生情况、残余分流情况、术前术后肺动脉压变化等多方面进行分析,通过3-12个月的随访来评价其疗效和安全性。以期能为PDA合并PAH的介入治疗适应证提供更多理论依据。 方法：选取在2009年1月1日～2011年12月31日3年期间在山东省立医院小儿心脏科实施PDA封堵术的患儿为研究对象,根据一定的纳入及排除标准,共入选60例,年龄1岁～18岁。术前均经常规体检、心电图(ECG)、经胸超声心动图(TTE)、心脏正侧位X线摄片等检查确诊。按照比所测PDA最窄处直径夯2-4mm的原则选取封堵器,封堵器采用美国AGA公司的Amplatzer蘑菇伞状PDA封堵器或国产蘑菇伞状PDA封堵器。严格按照介入治疗要求实施介入。手术结束后均抗生素预防感染治疗48小时。术后24h、1、3、6、12个月复查超声心动图及心电图进行随访,观察封堵器形态,残余分流情况及肺动脉压改变情况及有无并发症。 结果：60例患儿均完成封堵手术,大多数患者术中即刻压力下降明显,压力下降值达50%以上,术中观察20分钟压力无回升。随访至12个月绝大多数患者肺动脉压力基本正常,心影形态大小接近正常。即刻手术成功率95%(无残余分流),术前PASP、PAMP、AP均值分别为69.4±24.5mmHg、45.3±14.2mmHg、94.5±10.3mmHg,术后PASP.PAMP.AP均值分别为32.6±8.2mmHg、29.8±8.2mmHg、98.8±6.2mmHg。术前与术后PASP及PAMP差异有统计学意义(T=10.945,P=0.01)、(T=12.603,P=0.01)。术后PASP及PAMP显著低于治疗前。术前、术后AP差异无统计学意义(T=12.640,P=0.12)及动脉血氧饱和度均值差异(P0.05)无统计学意义。入选的60例患者封堵后,术后1月复查TTE可见左房内径(LAD)由术前30.7-5.0降为21.1±3.9(P0.01)、左室舒张末期内径(LVEDD)由术前49.24±6.2降为40.3±5.5(P0.05)、左室舒张末期容积(LVEDV)由术前114.7±38.9降为65.3±27.1ml(P0.01)、左室收缩末期容积(LVESV)由术前31.7±12.8m1降为25.2±10.9ml(P0.05)、左室每搏量(LVSV)由术前83.6±29.4ml降为53.1±24.6ml(P0.01)、左室射血分数(LVEF)由术前68.1士2.6%降为63.5±5.3%(P0.05)、左室短轴缩短率(LVFS)由术前36.7±5.9%降为32.4±6.2%(P0.05)、术后3个月LAD、LVEDV、 LVEDD、LVSV、LVESV、LVFSLVEF、较术后1个月无显著性差异(P0.05)。术后6个月LAD、LVEDV、LVEDD、LVSV、LVESV、LVFS、LVEF较术后1个月无显著性差异(P0.05)封堵术后10分降主动脉造影显示无残余分流57例,微量残余分流2例,少量残余分流1例。有残余分流者中1例1月随访时残余分流消失,1例随访12月仍存在少量残余分流。术后并发症少。 结论：PDA合并PAH患者行封堵器治疗,技术操作简便、安全、成功率高、并发症少,在严格掌握指征情况下中远期疗效确切,安全性好。
[Abstract]:Objective: Congenital Heart Disease (CHD) is the most common heart disease in children. The common types are PDA patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, etc. Since 1960s, PDA occluder has been the first to treat CHD. Since 1990s, with the continuous development and improvement of interventional instruments, interventional therapy has been carried out. The advantages of simple operation, safe and effective treatment, rapid recovery and so on are becoming increasingly prominent and widely used in the world. At present, there are more and more analysis on the efficacy of interventional therapy with occluder for various CHD, and more and more research on the interventional therapy of PDA combined with PAH is also increasing, but in some aspects of the study is not systematic, this study on the application of occluder in the treatment of PDA combined. PAH was analyzed in terms of success rate, complications, residual shunt, changes of pulmonary artery pressure before and after operation, and its efficacy and safety were evaluated by 3-12 months follow-up.
Methods: Sixty children aged 1 to 18 years who underwent PDA occlusion in the Department of Pediatric Cardiology of Shandong Provincial Hospital from January 1, 2009 to December 31, 2011 were enrolled according to certain inclusion and exclusion criteria. According to the principle of ramming 2-4 mm in the narrowest diameter of the PDA, the occluder was selected using Amplatzer mushroom umbrella-shaped PDA occluder made by AGA Company of America or domestic mushroom umbrella-shaped PDA occluder. Intervention was carried out strictly according to the requirements of interventional therapy. Antibiotics were used to prevent infection 48 hours after the operation. Echocardiogram and electrocardiogram were followed up at 6 and 12 months to observe occluder morphology, residual shunt, changes of pulmonary artery pressure and complications.
Results: All the 60 cases had completed the occlusion operation. Most of the patients had a significant decrease of pressure immediately, and the pressure dropped by more than 50% during the operation. The pressure did not rise during the observation of 20 minutes. The mean values of PAMP and AP were 69.4+24.5mmHg, 45.3+14.2mmHg, 94.5+10.3mmHg, 32.6+8.2mmHg, 29.8+8.2mmHg, 98.8+6.2mmHg, respectively. There was no significant difference between preoperative and postoperative PASP and PAMP (T = 10.945, P = 0.01), (T = 12.603, P = 0.01). The mean values of PASP and PAMP were significantly lower than those before and after surgery (P = 0.01). There was no significant difference in the mean value of arterial oxygen saturation (P 0.05) and academic significance (T = 12.640, P = 0.12). VEDV decreased from 114.7 (+ 38.9) to 65.3 (+ 27.1 ml) (P 0.01), left ventricular end systolic volume (LVESV) from 31.7 (+ 12.8 m1) to 25.2 (+ 10.9 ml) (P 0.05), left ventricular stroke volume (LVSV) from 83.6 (+ 29.4 ml) to 53.1 (+ 24.6 ml) (P 0.01), left ventricular ejection fraction (LVEF) from 68.1 (+ 2.6%) to 63.5 (+ 5.3%) and left ventricular short axis shortening (LVFS) from surgery. There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 3 months postoperatively (P 0.05). There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 6 months postoperatively (P 0.05). There were 2 cases with small residual shunt and 1 case with residual shunt. The residual shunt disappeared in 1 case after 1 month follow-up, and a small residual shunt still existed in 1 case after 12 months follow-up.
Conclusion: PDA combined with PAH patients with occluder treatment, the technical operation is simple, safe, high success rate, fewer complications, in strict control of the indications in the medium and long-term effect is accurate, safe.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4
[Abstract]:Objective: Congenital Heart Disease (CHD) is the most common heart disease in children. The common types are PDA patent ductus arteriosus, atrial septal defect, ventricular septal defect, pulmonary stenosis, etc. Since 1960s, PDA occluder has been the first to treat CHD. Since 1990s, with the continuous development and improvement of interventional instruments, interventional therapy has been carried out. The advantages of simple operation, safe and effective treatment, rapid recovery and so on are becoming increasingly prominent and widely used in the world. At present, there are more and more analysis on the efficacy of interventional therapy with occluder for various CHD, and more and more research on the interventional therapy of PDA combined with PAH is also increasing, but in some aspects of the study is not systematic, this study on the application of occluder in the treatment of PDA combined. PAH was analyzed in terms of success rate, complications, residual shunt, changes of pulmonary artery pressure before and after operation, and its efficacy and safety were evaluated by 3-12 months follow-up.
Methods: Sixty children aged 1 to 18 years who underwent PDA occlusion in the Department of Pediatric Cardiology of Shandong Provincial Hospital from January 1, 2009 to December 31, 2011 were enrolled according to certain inclusion and exclusion criteria. According to the principle of ramming 2-4 mm in the narrowest diameter of the PDA, the occluder was selected using Amplatzer mushroom umbrella-shaped PDA occluder made by AGA Company of America or domestic mushroom umbrella-shaped PDA occluder. Intervention was carried out strictly according to the requirements of interventional therapy. Antibiotics were used to prevent infection 48 hours after the operation. Echocardiogram and electrocardiogram were followed up at 6 and 12 months to observe occluder morphology, residual shunt, changes of pulmonary artery pressure and complications.
Results: All the 60 cases had completed the occlusion operation. Most of the patients had a significant decrease of pressure immediately, and the pressure dropped by more than 50% during the operation. The pressure did not rise during the observation of 20 minutes. The mean values of PAMP and AP were 69.4+24.5mmHg, 45.3+14.2mmHg, 94.5+10.3mmHg, 32.6+8.2mmHg, 29.8+8.2mmHg, 98.8+6.2mmHg, respectively. There was no significant difference between preoperative and postoperative PASP and PAMP (T = 10.945, P = 0.01), (T = 12.603, P = 0.01). The mean values of PASP and PAMP were significantly lower than those before and after surgery (P = 0.01). There was no significant difference in the mean value of arterial oxygen saturation (P 0.05) and academic significance (T = 12.640, P = 0.12). VEDV decreased from 114.7 (+ 38.9) to 65.3 (+ 27.1 ml) (P 0.01), left ventricular end systolic volume (LVESV) from 31.7 (+ 12.8 m1) to 25.2 (+ 10.9 ml) (P 0.05), left ventricular stroke volume (LVSV) from 83.6 (+ 29.4 ml) to 53.1 (+ 24.6 ml) (P 0.01), left ventricular ejection fraction (LVEF) from 68.1 (+ 2.6%) to 63.5 (+ 5.3%) and left ventricular short axis shortening (LVFS) from surgery. There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 3 months postoperatively (P 0.05). There was no significant difference in LAD, LVEDV, LVEDD, LVSV, LVESV, LVFSLVEF at 6 months postoperatively (P 0.05). There were 2 cases with small residual shunt and 1 case with residual shunt. The residual shunt disappeared in 1 case after 1 month follow-up, and a small residual shunt still existed in 1 case after 12 months follow-up.
Conclusion: PDA combined with PAH patients with occluder treatment, the technical operation is simple, safe, high success rate, fewer complications, in strict control of the indications in the medium and long-term effect is accurate, safe.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4
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相关期刊论文 前10条
1 温仁祝,林辉,何巍,彭青云,郑陈光,罗玉华;214例动脉导管未闭的外科治疗[J];广西医科大学学报;2000年06期
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