老年房间隔缺损介入封堵治疗疗效和安全性研究  

Appraisal of Efficacy and Safety of Intervention Treatment of Secondum Atrial Septal Defect in Agedness Patients

作　　者：周达新[1] 管丽华[1] 葛均波[1] 潘翠珍[1] 潘文明[1] 黄国倩[1] 

机构地区：[1]上海市心血管病研究所,复旦大学附属中山医院,上海200032

出　　处：《中国临床医学》2008年第1期12-15,共4页Chinese Journal of Clinical Medicine

摘　　要：目的：对65岁以上老年房间隔缺损（ASD）患者使用ASD封堵器（ASD0）进行介入封堵治疗，对其疗效和安全性进行随访临床研究。方法：老年继发孔型ASD患者48例，其中男性16例，女性32例，年龄在65～79岁（68.58±3.83岁），其中10例有阵发性心房颤动（AF），8例持续性AF，ASD大小在5～49mm（以最大直径计算）,肺动脉收缩压54.43±12.14mmHg（1mrnHg=0.133kPa），舒张压30.63±6.41mmHg，患者术前2d服用肠溶肠溶阿司匹林（ASP）200mg·dˉ^1，经股静脉穿刺，在X线下及体表超声心动图（TTE）或经食管超声心动图（TEE）的监测下使用国产ASDO进行封堵治疗，术后1个月改为ASP 100mg·dˉ^1，持续服用ASP治疗6个月。术前患有AF的患者服用华法灵治疗，维持凝血酶原国际标准比（INR）在2.0～2.5，4周以上。术后1、3、6个月门诊随访胸X线片和TTE。结果：48例患者中，2例在释放ASDO后即刻发现ASDO移位，手术后即刻成功率为91.7％，1例在手术后3d发现ASDO移位，成功率为89.6％，1例患者在封堵后6个月发现ASDO移位，成功率为87.5％。ASDO直径为7～42mm（29.44±12.14mm）。经导管测定肺动脉收缩压在34～89mmHg（50.21±13.16mmHg，1mmHg=0.133kPa），平均肺动脉压为22～48mmHg（30.63±6.41mmHg）；TTE封堵前测定肺动脉收缩压为42～92mmHg（54.43±12.14mmHg），封堵后测定缔动脉压力为收缩压为35～76mmHg（43.53±9.56mmHg），与封堵前相比有显著差异（P＜0.05）。术后2例发生头痛,发生率为4.5％（2/44），3d后消失．随访中无头痛。患者随访3～6个月，均未发现有栓塞性疾病。16例患者有不同程度心前区不适．发生率为34％（16/47）；术后随访中发生心律失常有16例，发生率为36.4％（16/44），其中10例为房性早搏，在以后随访中消失，术后2例出现I度房室传导阻滞，1例加速性交界性心动过速，1例既往无AF的患者出现阵发性AF。1�Objective：To evaluate efficacy and safety of intervention treatment of secondum atrial septal defect （ASD） in agedness patients. Methods：48 patients with secundum ASD, aged 65～79（68.58± 3.83） years old, 16 of whom were male, and 32 of whom were female, were studied. And 8 of whom suffered from persistent atrial fibrillation and 10 of whom suffered intermittent fibrillation. And the diameter of ASD was between 5mm to 49mm. The puhnonary systolic pressure and the pulmonary diastolic pressure detected by TTE was 35.83±8.13 mmHg（ 1 mmHg = 0.133 kPa）、30.63±6.41 mmHg（l mmHg = 0.133 kPa）respeetively. Patients took aspirin 200 mg/d 2 days before operation, The diameter of ASD closure device （ASDO） was between 5～49 mm. The procedure was guided by X-rays,transthoracic echocardiography （TTE） or by transesophageal echocardiography. ASDO were made in our country. A month later, patients changed dosage of asprin into 100mg/d. All patients suffered form atrial fibrillation were treated with warfarin and international normalized ratio（INR） had been kept between 2.0 to 2.5 for 4 weeks at least. Patients had been followed up 1 month, 3 months and 6 months after operation. X-rays, TTE and ECG were done to evaluated the efficiency and safety. Results： ASDO were found to shift to right ventricle in 2 patients after released instanter and success rate was 91,7%. And ASDO was found to move to right ventricle 3 days after procedure in a patient and success rate was 89.6%. ASDO was found to shift to pulmonary artery 6 months after procedure in another patient and success rate was 87.5%. The diameter of ASDO used was between 7mm to 42mm（29.44±12.14 mm）. The pulmonary systolic pressure and average pressure detected by catheter were 34～89 mmHg （50.21± 13.16 mmHg, 1 mmHg=0.133 kPa） ,22～48 mmHg （30.63±6.41 mmHg, 1 mmHg= 0.133 kPa） respectively, The pulmonary systolic pressure before andafter procedure were 42～92 mmHg （54. 43±12.14 mmHg, 1 mmHg=0.133 kPa）,35～76 mmHg （43.5

关 键 词：老年房间隔缺损 介入封堵 疗效 安全性 

分 类 号：R815[医药卫生—放射医学]