经胸超声引导外科微创封堵治疗先天性心脏病的临床研究

发布时间：2018-05-23 07:13

本文选题：先天性心脏病 + 房间隔缺损　；参考：《桂林医学院》2015年硕士论文

【摘要】：目的探讨经胸超声心动图引导下应用国产封堵器外科微创封堵治疗先天性心脏病的可行性与安全性,探索其对心肌重构及心功能的影响。方法2012年9月至2014年11月期间在我院诊治的31例先天性心脏病患者,其中男性12例,女性19例,年龄1岁～66岁(平均15.2±17.7岁)。所有患者术前均经常规体格检查、心电图、X线、TTE多切面(四腔心切面、左室长轴切面及剑突下双心房切面)确诊为先天性心脏病,其中单纯性VSD10例,直径3-8mm(平均5.4±1.35mm),单纯性ASD21例,直径5-32mm(平均11.4±5.3mm)。患者经胸部小切口开胸,非体外循环下在TTE引导下将封堵器固定于缺损位置,确保无残余分流及瓣膜功能障碍后释放封堵器。术后予以肠溶阿司匹林或潘生丁口服抗凝3个月。比较所有患者封堵术前、术后3个月左室内径(LV)、左房内径(LA)、右房内径(RA)和右室内径(RV)大小及左室射血分数(EF)变化。结果经胸超声心动图引导下,封堵术后3月,10例VSD患者术前术后心脏大小对比,LA由(31.87±6.91)mm降至(27.13±7.81)mmm(P0.05),LV由(33.98±7.43)mm降至(29.02±6.63：mm(P0.05),RV由(20.11±4.28)mm升至(22.97±3.65)mm(P0.05)EF(%)由(59.11±4.23)升至(62.14±3.57) (P0.05)。21例ASD患者术中封堵失败2例,19例ASD患者LV较术前相比,RA由(36.62±3.91)mm降至(32.92±4.57)mm(P0.05),RV由(21.41±2.39)mm降至(18.19±3.62)mm(P0.05),LV由(35.11±3.86)mm升至(39.15±6.52)mm(P0.05),EF(%)由(59.72±8.17)升至(65.64±7.89) (P0.05)。术后有4人出现轻度二尖瓣反流,跟踪随访1～6个月,1例房间隔缺损出现残余分流(直径3.5mm),其余所有患者未出现瓣膜反流,未出现残余分流、心律失常、房室传导阻滞、血栓、气胸和封堵器移位等相关并发症。结论经胸超声可多切面监测封堵过程,为先天性心脏病的微创封堵提供了一种新的引导方法和思路,为临床治疗提供更多的选择。经胸超声引导下外科微创封堵治疗先天性心脏病安全、可靠,成功率高。经胸小切口微创封堵治疗先天性心脏病能有效逆转心肌重构,提高心功能。
[Abstract]:Objective to investigate the feasibility and safety of transthoracic echocardiographic guided minimally invasive occlusion for congenital heart disease (CHD), and to explore the effects of transthoracic echocardiography on myocardial remodeling and cardiac function. Methods from September 2012 to November 2014, 31 patients with congenital heart disease, including 12 males and 19 females, aged from 1 to 66 years (mean 15.2 卤17.7 years), were treated in our hospital. All the patients were diagnosed as congenital heart disease by routine physical examination before operation. The patients were diagnosed as congenital heart disease by electrocardiogram X ray TTE multi-section (four chamber view, left ventricular long axis section and double atrium section of the left ventricular process). The diameter of simple VSD10 was 3. 8 mm (mean 5.4 卤1. 35 mm), and simple ASD21 was found in 3 8 mm (mean 5. 4 卤1. 35 mm). The diameter was 5-32 mm (mean 11.4 卤5.3 mm). The occluder was fixed in the defect position under the guidance of TTE without cardiopulmonary bypass to ensure the release of occluder after no residual shunt and valve dysfunction. Postoperative enteric aspirin or dipyridamole oral anticoagulant for 3 months. The changes of left ventricular diameter (LVN), left atrial diameter (LAA), right atrial diameter (RV), right ventricular diameter (RV) and left ventricular ejection fraction (EF) were compared in all patients before and 3 months after occlusion. Results under the guidance of transthoracic echocardiography, Comparison of cardiac size in 10 VSD patients before and after closure from 31.87 卤6.91)mm to 27.13 卤7.81mm 7.43)mm from 33.98 卤7.43)mm to 29.02 卤6.63mmP0.05RV from 20.11 卤4.28)mm to 22.97 卤3.65mmP0.05EFV) from 59.11 卤4.23 to 62.14 卤3.57). The RV decreased from 21.41 卤2.39)mm to 18.19 卤3.62 卤3.62 2.39)mm from 35.11 卤3.86)mm to 39.15 卤6.52 卤6.5mm / L from 59.72 卤8.17 to 65.64 卤7.89). There were 4 patients with mild mitral regurgitation after operation. 1 case with atrial septal defect (3. 5 mm in diameter) was followed up for 1 ~ 6 months. No valve regurgitation, no residual shunt, arrhythmia, atrioventricular block, thrombus were found in all other patients. Pneumothorax and occluder displacement and other related complications. Conclusion Transthoracic ultrasound can monitor the occlusion process on multiple sections, which provides a new guiding method and train of thought for minimally invasive occlusion of congenital heart disease, and provides more choices for clinical treatment. Transthoracic ultrasound guided minimally invasive closure of congenital heart disease is safe, reliable and successful. Minimally invasive transthoracic closure can effectively reverse myocardial remodeling and improve cardiac function.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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