介入治疗继发孔型房间隔缺损直径与所用封堵伞关系的研究
发布时间：2018-09-11 12:55
【摘要】：研究目的： 通过分析已行经导管继发孔型房间隔缺损(ASD)封堵术患者的相关资料,探讨经胸超声心动图(TTE)测量继发孔型房间隔缺损直径与所用封堵伞放置前后伞腰直径的关系,以助经导管房间隔缺损封堵术中封堵伞大小的选择。 研究方法： 第一部分：在山东省立医院小儿心脏科行经导管继发孔型房间隔缺损封堵术且资料完整的患者共205例,所有患者均行TTE测量ASD直径。将205例患者,按照ASD最大直径的不同,分为三组：A组(5mmASD直径12mm)65例、B组(12mmASD直径20mm)76例,C组(ASD直径≥20mm)64例。对经评价判断手术成功的患者相关资料进行统计分析；连续变量资料采用方差分析,分类变量资料采用卡方检验或Fisher确切概率法进行统计分析,对比研究不同组中TTE测量ASD直径与所用封堵伞伞腰之间的关系。 第二部分：在山东省立医院小儿心脏科成功行经导管继发孔型房间隔缺损(ASD)封堵术且临床资料与影像学资料均完整的患者144例,采用导管校准法测量放置后封堵伞伞腰直径,采用线性相关及线性回归分析,探讨TTE测量ASD直径与所用封堵伞放置后伞腰关系。 结果： 1、(1)205例患者中193例手术成功,手术成功率为94.1%。其中手术成功患者A组65例、B组73例、C组55例,各组手术成功率分别为100%、96.1%、85.9%。 (2)ASD直径在A组、B组、C组分别为8.89±1.86mm、15.16±2.06mm、24.69±4.01mm,ASD直径在任意两组之间P值均0.0001；所用封堵伞伞腰直径分别为10.73±2.31mim、18.38±3.60mm、28.84±4.80mm,所用封堵伞伞腰直径在任意两组之间P值均0.0001。 (3)对A组、B组、C组所用封堵伞放置前伞腰直径与ASD直径进行相关性检验,其相关系数分别为0.750、0.746、0.698,其P值均0.0001；所用封堵伞放置前伞腰直径与TTE测量ASD直径差值A组为1.87±1.49mm、B组为3.33±2.32mm、C组为4.52±3.19mm,此差值在A组与B组、A组与C组之间P值均小于0.0001,在B组与C组之间P值=0.033。所用封堵伞放置前伞腰直径与ASD直径差值的95%可信区间A组1.50～2.24mm、B组2.79～3.88mm、C组3.66～5.38mm。所用封堵伞放置前伞腰直径与ASD直径差值的90百分位数A组为4.0mm、B组为7.0mm、C组为10.0mm。 2、(1)144例患者TTE测量ASD直径平均值为15.46±6.65mm,所用封堵伞放置前伞腰直径平均值为18.36+7.83mm,所用封堵伞放置后伞腰直径平均值为15.44±6.63mm。 (2)TTE测量ASD直径与所用封堵伞放置后伞腰直径进行比较,其相关系数为0.936,P0.0001,具有统计学意义。将TTE测量ASD直径与所用封堵伞放置后伞腰直径建立直线回归方程,则所用封堵伞放置后伞腰直径=0.932×TTE测量ASD直径+1.030。 (3)对TTE测量ASD直径与所用封堵伞放置前伞腰直径进行相关性检验,其相关系数为0.948,P0.0001,具有统计学意义；将TTE测量ASD直径与所用封堵伞放置前伞腰直径建立直线回归方程,则所用封堵伞放置前伞腰直径=1.116×TTE测量ASD直径+1.110。 结论： 1、对于单纯性继发孔型房间隔缺损,经导管房间隔缺损介入治疗效果好；当ASD直径20mm时,手术成功率较高;当ASD直径≥20mm时,发生封堵伞脱落、移位及术后残余分流等并发症可能性增大。 2、对于小的ASD,所用封堵伞伞腰直径与TTE测量ASD直径差值较小：当缺损直径小于12mm时,所选用封堵伞伞腰直径比ASD直径大0-4mm；当缺损直径≥12mm、但20mm时,所选用封堵伞伞腰直径比ASD直径大1-7mm;而对于较大缺损,所用封堵伞伞腰直径与TTE测量ASD直径差值较大,当ASD直径≥20mm时,所选用封堵伞伞腰直径比ASD直径大2～10mm。 3、经胸超声心动图(TTE)能够准确测量房间隔缺损直径,并且作为一种无创性影像学检查方法,在经导管房间隔缺损的介入治疗中具有重要的指导意义。 4、TTE测量ASD直径与所用封堵伞放置后伞腰直径存在相关性,建立直线回归方程为所用封堵伞放置后伞腰直径=0.932×TTE测量ASD直径+1.030。 5、TTE测量ASD直径与所用封堵伞放置前伞腰直径建立回归方程为所用封堵伞放置前伞腰直径=1.116xTTE测量ASD直径+1.110。
[Abstract]:Research purposes:
To investigate the relationship between the diameter of secundum atrial septal defect (ASD) measured by transthoracic echocardiography (TTE) and the lumbar umbrella diameter before and after placement of the occluder umbrella, and to help the selection of the size of the occluder in transcatheter ASD occlusion.
Research methods:
The first part: 205 cases of ASD were performed transcatheter closure of secundum atrial septal defect in the Department of Pediatric Cardiology, Shandong Provincial Hospital. All patients were measured ASD diameter by TTE. 205 cases were divided into three groups according to the maximum diameter of ASD: 65 cases in group A (5 mm ASD diameter 12 mm), 76 cases in group B (12 mm ASD diameter 20 mm), and 76 cases in group C (ASD diameter 20 mm). Sixty-four patients with diameter (> 20 mm) were analyzed statistically. The data of continuous variables were analyzed by ANOVA, and the data of classified variables were analyzed by Chi-square test or Fisher exact probability method.
The second part: 144 cases of ASD were successfully treated by transcatheter closure in the Department of Pediatric Cardiology of Shandong Provincial Hospital. The diameter of umbrella waist was measured by catheter calibration method. The linear correlation and linear regression analysis were used to explore the relationship between TTE and ASD diameter. The relationship between the umbrella and the waist after the umbrella is placed.
Result:
1. (1) Among 205 cases, 193 cases were successfully operated, the success rate was 94.1%. Among them, 65 cases in group A, 73 cases in group B and 55 cases in group C were successfully operated. The success rates of each group were 100%, 96.1% and 85.9% respectively.
(2) The diameter of ASD in group A, group B, group C were 8.89 (+ 1.86 mm), 15.16 (+ 2.06 mm), 24.69 (+ 4.01 mm), and the diameter of ASD was 0.0001 between any two groups; the lumbar diameter of the occluding umbrella used was 10.73 (+ 2.31 mim), 18.38 (+ 3.60 mm), 28.84 (+ 4.80 mm), and the lumbar diameter of the occluding umbrella used was 0.0001.
(3) The correlation between the lumbar diameter and the diameter of ASD in group A, group B and group C was examined, and the correlation coefficients were 0.750, 0.746 and 0.698, respectively, with P values of 0.0001. The difference between the lumbar diameter and the diameter of ASD measured by TTE in group A and group B was 1.87 (+ 1.49mm), 3.33 (+ 2.32mm) and 4.52 (+ 3.19mm) respectively. The P value between group B and group C was less than 0.0001. The P value between group B and group C was 0.033. The 95% confidence interval of the difference between the lumbar diameter and the diameter of ASD was 1.50-2.24 mm in group A, 2.79-3.88 mm in group B, 3.66-5.38 mm in group C. The difference between the lumbar diameter and the diameter of ASD was 4.0 mm in group A, 7.0 mm in group B, and 10.0 mm in group C. .0mm.
2. (1) The mean diameter of ASD measured by TTE in 144 patients was 15.46 (+ 6.65 mm). The mean diameter of lumbar umbrella was 18.36 + 7.83 mm. The average diameter of lumbar umbrella was 15.44 (+ 6.63 mm) after placement of the occluding umbrella.
(2) The correlation coefficient of ASD diameter measured by TTE was 0.936, P 0.0001, which was statistically significant. The linear regression equation was established between ASD diameter measured by TTE and lumbar diameter measured by using plugging umbrella. The lumbar diameter measured by using plugging umbrella was 0.932 *TTE and ASD diameter + 1.030.
(3) The correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella was tested, and the correlation coefficient was 0.948, P 0.0001, which was statistically significant; the linear regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella, and the lumbar diameter measured by the plugging umbrella = 1.116 *TTE and the ASD diameter + 1.110.
Conclusion:
1. For simple secundum atrial septal defect, transcatheter atrial septal defect interventional therapy is effective; when the diameter of ASD is 20 mm, the surgical success rate is higher; when the diameter of ASD is more than 20 mm, occluding umbrella shedding, displacement and residual shunt after operation are more likely to occur.
2. For small ASD, the difference between the lumbar diameter of occluding umbrella and that of ASD measured by TTE is small: when the defect diameter is less than 12 mm, the lumbar diameter of occluding umbrella is 0-4 mm larger than that of ASD; when the defect diameter is more than 12 mm, but 20 mm, the lumbar diameter of occluding umbrella is 1-7 mm larger than that of ASD; for larger defect, the lumbar diameter of occluding umbrella is used. When the diameter of ASD is more than 20 mm, the diameter of umbrella waist is 2-10 mm larger than that of ASD.
3. Transthoracic echocardiography (TTE) can accurately measure the diameter of atrial septal defect, and as a non-invasive imaging method, it has important guiding significance in the interventional treatment of transcatheter atrial septal defect.
4. There is a correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella after placement of the plugging umbrella. A linear regression equation is established to measure the lumbar diameter of the umbrella after placement of the plugging umbrella = 0.932 * TTE and the lumbar diameter of the umbrella + 1.030.
5. The regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the front umbrella placed with the plugging umbrella. The lumbar diameter of the front umbrella placed with the plugging umbrella = 1.116xTTE was used to measure the ASD diameter + 1.110.
【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
本文编号：2236745
[Abstract]:Research purposes:
To investigate the relationship between the diameter of secundum atrial septal defect (ASD) measured by transthoracic echocardiography (TTE) and the lumbar umbrella diameter before and after placement of the occluder umbrella, and to help the selection of the size of the occluder in transcatheter ASD occlusion.
Research methods:
The first part: 205 cases of ASD were performed transcatheter closure of secundum atrial septal defect in the Department of Pediatric Cardiology, Shandong Provincial Hospital. All patients were measured ASD diameter by TTE. 205 cases were divided into three groups according to the maximum diameter of ASD: 65 cases in group A (5 mm ASD diameter 12 mm), 76 cases in group B (12 mm ASD diameter 20 mm), and 76 cases in group C (ASD diameter 20 mm). Sixty-four patients with diameter (> 20 mm) were analyzed statistically. The data of continuous variables were analyzed by ANOVA, and the data of classified variables were analyzed by Chi-square test or Fisher exact probability method.
The second part: 144 cases of ASD were successfully treated by transcatheter closure in the Department of Pediatric Cardiology of Shandong Provincial Hospital. The diameter of umbrella waist was measured by catheter calibration method. The linear correlation and linear regression analysis were used to explore the relationship between TTE and ASD diameter. The relationship between the umbrella and the waist after the umbrella is placed.
Result:
1. (1) Among 205 cases, 193 cases were successfully operated, the success rate was 94.1%. Among them, 65 cases in group A, 73 cases in group B and 55 cases in group C were successfully operated. The success rates of each group were 100%, 96.1% and 85.9% respectively.
(2) The diameter of ASD in group A, group B, group C were 8.89 (+ 1.86 mm), 15.16 (+ 2.06 mm), 24.69 (+ 4.01 mm), and the diameter of ASD was 0.0001 between any two groups; the lumbar diameter of the occluding umbrella used was 10.73 (+ 2.31 mim), 18.38 (+ 3.60 mm), 28.84 (+ 4.80 mm), and the lumbar diameter of the occluding umbrella used was 0.0001.
(3) The correlation between the lumbar diameter and the diameter of ASD in group A, group B and group C was examined, and the correlation coefficients were 0.750, 0.746 and 0.698, respectively, with P values of 0.0001. The difference between the lumbar diameter and the diameter of ASD measured by TTE in group A and group B was 1.87 (+ 1.49mm), 3.33 (+ 2.32mm) and 4.52 (+ 3.19mm) respectively. The P value between group B and group C was less than 0.0001. The P value between group B and group C was 0.033. The 95% confidence interval of the difference between the lumbar diameter and the diameter of ASD was 1.50-2.24 mm in group A, 2.79-3.88 mm in group B, 3.66-5.38 mm in group C. The difference between the lumbar diameter and the diameter of ASD was 4.0 mm in group A, 7.0 mm in group B, and 10.0 mm in group C. .0mm.
2. (1) The mean diameter of ASD measured by TTE in 144 patients was 15.46 (+ 6.65 mm). The mean diameter of lumbar umbrella was 18.36 + 7.83 mm. The average diameter of lumbar umbrella was 15.44 (+ 6.63 mm) after placement of the occluding umbrella.
(2) The correlation coefficient of ASD diameter measured by TTE was 0.936, P 0.0001, which was statistically significant. The linear regression equation was established between ASD diameter measured by TTE and lumbar diameter measured by using plugging umbrella. The lumbar diameter measured by using plugging umbrella was 0.932 *TTE and ASD diameter + 1.030.
(3) The correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella was tested, and the correlation coefficient was 0.948, P 0.0001, which was statistically significant; the linear regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the umbrella before the placement of the plugging umbrella, and the lumbar diameter measured by the plugging umbrella = 1.116 *TTE and the ASD diameter + 1.110.
Conclusion:
1. For simple secundum atrial septal defect, transcatheter atrial septal defect interventional therapy is effective; when the diameter of ASD is 20 mm, the surgical success rate is higher; when the diameter of ASD is more than 20 mm, occluding umbrella shedding, displacement and residual shunt after operation are more likely to occur.
2. For small ASD, the difference between the lumbar diameter of occluding umbrella and that of ASD measured by TTE is small: when the defect diameter is less than 12 mm, the lumbar diameter of occluding umbrella is 0-4 mm larger than that of ASD; when the defect diameter is more than 12 mm, but 20 mm, the lumbar diameter of occluding umbrella is 1-7 mm larger than that of ASD; for larger defect, the lumbar diameter of occluding umbrella is used. When the diameter of ASD is more than 20 mm, the diameter of umbrella waist is 2-10 mm larger than that of ASD.
3. Transthoracic echocardiography (TTE) can accurately measure the diameter of atrial septal defect, and as a non-invasive imaging method, it has important guiding significance in the interventional treatment of transcatheter atrial septal defect.
4. There is a correlation between the ASD diameter measured by TTE and the lumbar diameter of the umbrella after placement of the plugging umbrella. A linear regression equation is established to measure the lumbar diameter of the umbrella after placement of the plugging umbrella = 0.932 * TTE and the lumbar diameter of the umbrella + 1.030.
5. The regression equation was established between the ASD diameter measured by TTE and the lumbar diameter of the front umbrella placed with the plugging umbrella. The lumbar diameter of the front umbrella placed with the plugging umbrella = 1.116xTTE was used to measure the ASD diameter + 1.110.
【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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