经皮穿刺动脉导管闭合术的临床应用及并发症的处理  

Clinical use and complication management of percutaneous closure of patent ductus arteriosus

作　　者：杜修海[1] 张卫泽[1] 胡静冷[1] 张明旭[1] 刘春梅[1] 

机构地区：[1]解放军兰州军区总医院

出　　处：《中国介入心脏病学杂志》1996年第2期52-54,共3页Chinese Journal of Interventional Cardiology

摘　　要：采用改进的Ｐｏｒｓｔｍａｎｎ法对８例动脉导管未闭（ＰＤＡ）患者实施经皮穿刺堵塞术。以彩色多普勒探测ＰＤＡ大小，结合导管尺测量塞子并实施堵塞术。６例关闭成功，其血液动力学各参数均明显改善或恢复正常。随访２～４年无栓子移位或再分流发生。失败２例：１例未闭导管呈反漏斗型，塞子脱入肺动脉，经送至股静脉并切开取出；另１例系股动脉太细而不能送入选定的塞子。因此，严格选择适应症的患者是非常重要的。By using improved Porstmann method,the percutaneous closure of patent ductus arteriosus (PDA) was performed in 8 patients aged from 7 to 39 (mean 24.6±8. 9) years. The colour Doppler,bal loon exploration of the defect and a catheter scale examination of the foam plug used for choice of patients, measurment of PDA' dilated diameter and plug closure. Successful occlusion was achieved in 6 cases. The shunts from aotic artery to pulmonary artery were blocked as soon as the plug fixed in PDA. The pressure of pulmonary artery and right ventricle decreased (2.9±0.9 vs 1. 6±1. 3 P<0.01) and the cardic index increased (2.7±0. 7 vs 3. 6± 0. 5 P<0. 05) significantly after occlusion. The were no plug displacement and return to normal. There were no plug displacement and recanalization in 2￣4 yea's follow up. The bradycardia,hypotension or even shock would occure at the time of about 30 minutes after the closure,but this complication can be avoided by early managemet. Two cases were unsuccessful. One's plug dislocated into pulmonary artery through inverse funnel shaped PDA,The plug was pushed to femoral vein with a catheter and taken it off from there by incised the vein. The other one' s femoral artery was thiner than PDA and the chosen plug could not be placed into the artery. So the choice of suitable patient was impor tant.

关 键 词：动脉导管未闭 堵塞术 心脏外科手术 

分 类 号：R654.205[医药卫生—外科学]