手术治疗12岁以上继发孔型房间隔缺损的回顾分析

发布时间：2018-05-30 23:38

本文选题：房间隔缺损 + 年龄　；参考：《昆明医科大学》2015年硕士论文

【摘要】：[背景和目的]：目前对于成人房间隔缺损的干预时机仍存在争议,国际上不少心脏中心认为成人房间隔缺损一经确诊就应及早手术。然而,支持该观点的证据却不够充分。本研究回顾性分析了12岁以上不同年龄段继发孔型ASD患者术前、术中、术后临床资料及手术前后心脏几何形态变化,以探寻治疗成人房间隔缺损的最佳治疗时机。[材料和方法]：数据资料来源于云南省心血管疾病研究所2012年1月至2014年9月期间,年龄大于12岁的469名单纯继发孔型房间隔缺损患者。根据年龄分为6组：A(12-20岁)、B(21-30岁)、C(31-40岁)、D(41-50岁)、E(51-60岁)、F(60岁)。采集患者入院前存在循环系统症状情况,收集心电图、心胸比例、心脏超声等检查结果、手术及住院相关资料,并对其进行统计学分析。[结果]：经统计学分析,各年龄组40岁以上患者(D、E、F组)循环系统相关症状发生率及心律失常发生率均高于40岁以下患者(A、B、C组)(P0.05)；40岁以上患者(D、E、F组)心胸比例、肺动脉压大于40岁以下患者(A、B、C组)；40岁以上患者(D、E、F组)动脉氧饱和度较40岁以下患者(A、B、C组)明显降低(P0.05)；40岁以上患者(D、E、F组)术前右室舒张末期内径(RVEDD)、右室流出道内径(RVOTD)、左房内径(LAD)、右房内径(RAD)均大于40岁以下患者(A、B、C组)(P0.05)；所有患者手术后72小时,右室舒张末期内径(RVEDD)、左房内径(LAD)、右房内径(RAD)均较术前明显减小,并于术后3月进一步减小(P0.05)；术后72小时左房内径较术前明显减小,而术后3月轻度扩大；术后72小时、术后3月左室舒张末期内径均较前增大(P0.05)。经胸骨正中切口房间隔缺损修补术治疗的40岁以上患者(D、E、F组)手术失血量、术后引流量、ICU停留时间、总住院时间均较40岁以下患者(A、B、C组)增加或延长(P0.05),但手术时间、阻断时间、体外循环时间无统计学差异(P0.05)。[结论]：随年龄的增长,特别是40岁以后ASD患者循环系统症状发生率、心律失常发生率、心胸比例、肺动脉压力明显增加,动脉氧饱和度降低；不同年龄段继发孔ASD患者经手术治疗后心脏几何形态均得到有效恢复；经胸骨正中切口房间隔缺损修补术治疗的高龄患者手术失血量、术后引流量、ICU停留时间、总住院时间均较低龄患者有不同程度增加或延长。建议继发孔房间隔缺损患者于40岁前行手术治疗。高龄并不是手术禁忌,当患者年龄大于40岁,肺血管阻力10wood,同时不吸氧状态下动脉血氧饱和度93%时,手术治疗是安全的,并可减少相关并发症的发生。
[Abstract]:Background and objective: at present, the timing of intervention on adult atrial septal defect is still controversial. Many heart centers in the world believe that adult atrial septal defect should be operated on as soon as it is diagnosed. However, the evidence to support this view is insufficient. In this study, we retrospectively analyzed the changes of cardiac geometry before, during and after operation in patients over 12 years of age with secondary perforated ASD, in order to explore the best time for the treatment of adult atrial septal defect (ASD). Materials and methods: data were obtained from 469 patients aged over 12 years from January 2012 to September 2014 in Yunnan Institute of Cardiovascular Diseases. According to the age, 6 groups were divided into 6 groups, the age group was 12 to 20 years old, the age group was BX 21-30 years old, the age was 31 to 40 years old, the age was 41 to 50 years old, and the age was 51-60 years old, and the age group was 60 years old. The symptoms of circulatory system were collected before admission, electrocardiogram (ECG), cardiothoracic ratio (ECG), cardiac ultrasound, and related data of operation and hospitalization were collected and analyzed statistically. [results] by statistical analysis, the incidence of circulatory system related symptoms and arrhythmias in patients over 40 years of age were higher than those in patients under 40 years old. Pulmonary artery pressure greater than 40 years of age in patients over 40 years of age (n = 40) arterial oxygen saturation was significantly lower than that in patients under 40 years of age (n = 40). (P > 40) right ventricular end-diastolic diameter (RVEDDD), right ventricular outflow tract (RV) and right ventricular outflow tract (RV) were significantly decreased in patients over 40 years of age (n = 40). The RVOTD, left atrial diameter and right atrial diameter were larger than those of patients under 40 years old. Right ventricular end-diastolic diameter (RVEDDN), left atrial diameter (LADV), right atrial diameter (RAD) were significantly decreased compared with those before operation, and further decreased in 3 months after operation (P 0.05), 72 hours after operation decreased significantly compared with those before operation, and slightly enlarged in 3 months after operation, 72 hours after operation, and 72 hours after operation, the diameter of left atrium decreased significantly, and the diameter of left atrium increased slightly at 3 months after operation. The end diastolic diameter of left ventricle increased at 3 months after operation compared with the anterior end diastolic diameter (P 0.05). Patients over 40 years old treated with atrial septal defect through sternum median incision.) the amount of blood loss, postoperative drainage and ICU stay time, total hospital stay time were increased or prolonged compared with those of patients under 40 years of age (P 0.05), but the operation time and interdiction time were increased or prolonged, but the operation time and the interdiction time were increased, compared with those of the patients under 40 years old. The time of cardiopulmonary bypass had no statistical difference (P 0.05). [conclusion]: the incidence of circulatory system symptoms, arrhythmia, cardiothoracic ratio, pulmonary artery pressure and arterial oxygen saturation decreased with age, especially after 40 years of age. The cardiac geometry of ASD patients with secondary foramen in different ages was recovered effectively after surgical treatment, and the blood loss and postoperative drainage time of elderly patients treated with atrial septal defect repair through median sternal incision were measured. The total length of hospitalization was increased or prolonged in varying degrees compared with younger patients. It is recommended that the patients with atrial septal defect of secondary foramen be operated before 40 years old. Old age is not a contraindication for surgery. When the patient is over 40 years of age, pulmonary vascular resistance is 10wood, and oxygen saturation of arterial blood is 93 under the condition of no oxygen inhalation, the surgical treatment is safe and can reduce the incidence of related complications.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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