先天性室间隔缺损个体化介入治疗与外科手术对比研究
发布时间：2018-10-24 06:58
【摘要】：室间隔缺损(ventricular septal defect,VSD)是最常见的左向右分流型心脏畸形,易形成肺动脉高压,甚至艾森曼格综合征,导致心功能降低,引起患者反复的肺部感染,影响其生长发育,严重者可导致心衰或猝死。目前其常用的手术方式为外科修补手术治疗和经导管介入封堵治疗。前者较成熟,成功率高,但需开胸、建立体外循环,输血等;后者发展虽较晚,且受器械大小及患者年龄的限制,但因手术创伤小,恢复快等优势,逐渐成为国内治疗室间隔缺损的研究热点和难点,人们对其长期安全性及有效性研究较少。本文通过对分别接受两种手术方法进行治疗的患者进行随访,对比观察两者的疗效。研究纳入2010年1月至2011年12月在空军总医院心脏中心住院并接受治疗的膜周部室间隔缺损患者109例,按手术方式分为介入封堵组(61例)和外科修补组(48例)。对比两组患者术前基本情况(性别、年龄、体重、室间隔缺损大小、有无合并膜部瘤等),术中、术后(两组手术成功率、输血量、住院时间、住院总费用等)及患者并发症的发生和转归情况。随访观察两组患者术前、术后1天、术后3年的心电图和心脏彩超的变化,比较两种手术方法对心功能,如射血分数(EF)、短轴缩短率(FS),心电指标,如QT离散度(QTd)、矫正QT离散度(QTcd)、V1导联终末电势(ptfv1)、Macruz指数的影响。研究发现介入封堵和外科修补术前性别、年龄、体重、室间隔缺损大小、合并膜部瘤例数均无明显差别;介入封堵和外科修补技术成功率分别为96.72%,100%;输血量分别为0ml,(629.17±300.32)ml;住院时间分别为(6.11±1.82)天,(12.90±1.68)天;住院总费用分别为(23973±2551)元,(20395±4357)元。介入封堵组住院时间较外科手术组明显短,且不需要输血,但外科手术总费用相对较低,差异有统计学意义(P0.05)。术后介入封堵组和外科修补组总并发症发生率分别为22.95%,37.50%,两组比较无明显差异;其中新增心律失常发生率分别为8.20%,10.42%,主要心律失常有右束支传导阻滞、室性期前收缩、房性期前收缩、交界性心律、短P-R间期等,两组均无左束支传导阻滞及三度房室传导阻滞等严重心律失常的发生;新增瓣膜反流分别为6.56%,6.25%,主要为少量瓣膜反流,两组均无严重瓣膜反流的发生;残余分流发生率分别为3.28%,2.08%,均为微量-少量残余分流;两组比较新增心律失常发生率、瓣膜反流、残余分流发生率均无统计学差异,且多数并发症在随访期间逐渐恢复。介入封堵及外科修补心功能均较术前明显改善,两组比较无明显差异(P0.05)。介入封堵及外科手术后心电图QTd、QTcd、ptfv1、macruz值均较术前明显缩短,两组组间比较无显著差异(P0.05)。个体化介入封堵治疗膜周部VSD与外科修补相比,具有成功率高、并发症少的特点,且不需要输血及开胸,恢复快。其中长期疗效及对心功能、心电学指标的改善情况与外科手术相当。介入封堵具有长期安全性及有效性,对于符合介入治疗标准的先天性膜周部VSD患者,采用个体化介入封堵可作为有效治疗方法之一。
[Abstract]:Ventricular septal defect (VSD) is the most common left-to-right shunt type cardiac malformation, which is easy to form pulmonary hypertension, or even Asenmann's syndrome, which leads to a decrease in cardiac function, which causes repeated pulmonary infection of the patient and affects its development. At present, the surgical method is used for the surgical repair of surgical repair and transcatheter closure of the catheter. The former is mature and mature, but needs to open chest, establish extracorporeal circulation, blood transfusion, etc. The development of the latter is relatively late and is limited by the size of the device and the age of the patient, but due to the advantages of small operation trauma, quick recovery and the like, the former gradually becomes the research hotspot and difficulty in the treatment of ventricular septal defect in China. There is little research on long-term safety and effectiveness of people. Through follow-up of the patients treated with two kinds of surgical methods, the effect of the two methods was compared. A total of 109 patients with ventricular septal defect were enrolled and treated at the heart center of the Air Force Hospital from January 2010 to December 2011, and were divided into two groups (61 cases) and surgical repair group (48 cases). To compare the basic condition (sex, age, body weight, ventricular septal defect size, presence or absence of combined membrane tumor, etc.) in the two groups, intraoperative, postoperative (two groups of surgical success rate, transfusion volume, hospital stay, total hospital total cost, etc.), and the occurrence and outcome of complications of the patients. The cardiac function, such as ejection fraction (EF), short axis shortening (FS), ECG index, such as QT dispersion (QTd), corrected QT dispersion (QTcd), were compared between two groups of patients before operation, 1 day after operation, 3-year post-operation electrocardiogram and cardiac color ultrasound. The effect of V1 on terminal potential (ptfv1) and Macruz index. The results showed that there was no significant difference between sex, age, body weight, ventricular septal defect and size of ventricular septal defect before interventional occlusion and surgical repair. The success rate of interventional occlusion and surgical repair was 96. 72% and 100% respectively, and the blood transfusion volume was 0ml, (629. 17, 300. 32) ml, respectively; The hospitalization time was (6. 11) 1. 82) days, (12. 90 days 1. 68) days; the total cost of hospitalization was (23973 65.2551) Yuan, (20395 1964357) Yuan. The hospitalization time of interventional occlusion group was shorter than that in the surgical group, and no blood transfusion was needed, but the total cost of surgery was relatively low and the difference was statistically significant (P0.05). The incidence of total complications in interventional occlusion group and surgical repair group were 22. 95%, 37. 50%, respectively. There was no significant difference between the two groups. Among them, the incidence of newly increased arrhythmia was 8. 20%, 10. 42% respectively. The main arrhythmia had right bundle branch conduction block, pre-chamber contraction and pre-stage contraction. At the junctional rhythm, short P-R interval and so on, there were no left bundle branch block in the two groups and the occurrence of severe arrhythmia, such as atrioventricular block, and the reverse flow of the new valve was 6.56% and 6.25% respectively. The incidence of residual shunt was 3.28% and 2.08%, both of which were trace-small amount of residual shunt. There was no statistical difference in the incidence of newly increased arrhythmia, reverse flow and residual shunt in the two groups, and most of the complications were gradually restored during follow-up. There was no significant difference between the two groups (P0.05). The values of QTd, QTcd, ptfv1 and macruz in interventional occlusion and post-surgical procedure were significantly shorter than those before operation (P <0.05). Compared with the surgical repair, the VSD and the surgical repair method of the individualized interventional occlusion treatment membrane week part have the characteristics of low toxicity and less complications, and no blood transfusion and chest opening can be needed, and the recovery is rapid. The long-term efficacy and improvement in cardiac function and cardiac electrical parameters were comparable to those of surgery. Interventional occlusion has long-term safety and effectiveness. For the patients with congenital membranous peripheral VSD conforming to the interventional therapy standard, individualized interventional occlusion can be used as one of the effective treatment methods.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.1
本文编号：2290653
[Abstract]:Ventricular septal defect (VSD) is the most common left-to-right shunt type cardiac malformation, which is easy to form pulmonary hypertension, or even Asenmann's syndrome, which leads to a decrease in cardiac function, which causes repeated pulmonary infection of the patient and affects its development. At present, the surgical method is used for the surgical repair of surgical repair and transcatheter closure of the catheter. The former is mature and mature, but needs to open chest, establish extracorporeal circulation, blood transfusion, etc. The development of the latter is relatively late and is limited by the size of the device and the age of the patient, but due to the advantages of small operation trauma, quick recovery and the like, the former gradually becomes the research hotspot and difficulty in the treatment of ventricular septal defect in China. There is little research on long-term safety and effectiveness of people. Through follow-up of the patients treated with two kinds of surgical methods, the effect of the two methods was compared. A total of 109 patients with ventricular septal defect were enrolled and treated at the heart center of the Air Force Hospital from January 2010 to December 2011, and were divided into two groups (61 cases) and surgical repair group (48 cases). To compare the basic condition (sex, age, body weight, ventricular septal defect size, presence or absence of combined membrane tumor, etc.) in the two groups, intraoperative, postoperative (two groups of surgical success rate, transfusion volume, hospital stay, total hospital total cost, etc.), and the occurrence and outcome of complications of the patients. The cardiac function, such as ejection fraction (EF), short axis shortening (FS), ECG index, such as QT dispersion (QTd), corrected QT dispersion (QTcd), were compared between two groups of patients before operation, 1 day after operation, 3-year post-operation electrocardiogram and cardiac color ultrasound. The effect of V1 on terminal potential (ptfv1) and Macruz index. The results showed that there was no significant difference between sex, age, body weight, ventricular septal defect and size of ventricular septal defect before interventional occlusion and surgical repair. The success rate of interventional occlusion and surgical repair was 96. 72% and 100% respectively, and the blood transfusion volume was 0ml, (629. 17, 300. 32) ml, respectively; The hospitalization time was (6. 11) 1. 82) days, (12. 90 days 1. 68) days; the total cost of hospitalization was (23973 65.2551) Yuan, (20395 1964357) Yuan. The hospitalization time of interventional occlusion group was shorter than that in the surgical group, and no blood transfusion was needed, but the total cost of surgery was relatively low and the difference was statistically significant (P0.05). The incidence of total complications in interventional occlusion group and surgical repair group were 22. 95%, 37. 50%, respectively. There was no significant difference between the two groups. Among them, the incidence of newly increased arrhythmia was 8. 20%, 10. 42% respectively. The main arrhythmia had right bundle branch conduction block, pre-chamber contraction and pre-stage contraction. At the junctional rhythm, short P-R interval and so on, there were no left bundle branch block in the two groups and the occurrence of severe arrhythmia, such as atrioventricular block, and the reverse flow of the new valve was 6.56% and 6.25% respectively. The incidence of residual shunt was 3.28% and 2.08%, both of which were trace-small amount of residual shunt. There was no statistical difference in the incidence of newly increased arrhythmia, reverse flow and residual shunt in the two groups, and most of the complications were gradually restored during follow-up. There was no significant difference between the two groups (P0.05). The values of QTd, QTcd, ptfv1 and macruz in interventional occlusion and post-surgical procedure were significantly shorter than those before operation (P <0.05). Compared with the surgical repair, the VSD and the surgical repair method of the individualized interventional occlusion treatment membrane week part have the characteristics of low toxicity and less complications, and no blood transfusion and chest opening can be needed, and the recovery is rapid. The long-term efficacy and improvement in cardiac function and cardiac electrical parameters were comparable to those of surgery. Interventional occlusion has long-term safety and effectiveness. For the patients with congenital membranous peripheral VSD conforming to the interventional therapy standard, individualized interventional occlusion can be used as one of the effective treatment methods.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.1
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