国产蘑菇伞介入治疗成人动脉导管未闭的临床疗效评价  

Clinical evaluation of catheter closure of patent ductus arteriosus by Chinese-made mushroom-shape occluder in adults

作　　者：代政学[1] 沈贵冬[2] 李寰[1] 张玉顺[3] 郭文怡[1] 王海昌[1] 杨省利[1] 

机构地区：[1]第四军医大学西京医院心内科,陕西西安710032 [2]安康市中心医院心内科,陕西安康725000 [3]西安交通大学第一附属医院心内二科,陕西西安710061

出　　处：《心脏杂志》2009年第6期823-825,共3页Chinese Heart Journal

摘　　要：目的： 评价国产蘑菇伞经导管介入治疗成人动脉导管未闭（PDA）的临床疗效。方法： 选择我科156（男54，女102）例成人PDA实施经导管介入治疗的患者，年龄18～65（32±13）岁；体质量43.8～68.5（51±8）kg；行右心导管检查测定肺动脉压力、主动脉压力，行主动脉弓降部造影，确定PDA位置、形状及大小，PDA最窄处内径1.5～18.2 （5±5）mm。以国产蘑菇伞堵闭器行介入治疗，根据封堵实验决定能否行永久封堵。术后24 h、1、3、6 和12个月行彩色多普勒超声心动图检查随访。结果： 4例封堵后30 min肺动脉收缩压无下降，反而有轻度上升，考虑为阻力性重度肺动脉高压，撤出封堵器。余152例成功地植入封堵器，术后30 min肺动脉压收缩压由术前（48±23）mmHg降为（36±12）mmHg（P〈0.05），肺动脉平均压降由术前（40±14）mmHg降为（27±11）mmHg（P〈0.05），主动脉压由术前（102±13）mmHg变化至（107±14）mmHg（P〉0.05）。术后30 min主动脉弓降部造影显示，119例（78.3％）封堵完全，33例（21.7％）可见极少量残余分流，术后24 h心脏彩超复查147例（96.7％）封堵完全，5例（3.3％）有少量残余分流，术后1个月彩超复查皆无残余分流；无再通和堵闭器移位等并发症发生。结论： 在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。AIM： To evaluate the treatment efficiency of catheter closure of patent ductus arteriosus （PDA） by Chinese-made mushroom-shape occluder in adults. METHODS： A total of 156 adults with PDA （54 males and 102 females） underwent attempted catheter closure by Chinese-made mushroom-shape occluder. Pulmonary arterial pressure, aortic pressure and oxygen saturation were measured. Aortography showed that the mean PDA diameter of the narrowest segment was （5.2±4.9） mm （range： 1.5-18.2 mm）. Lateral descending aortographies were performed to evaluate the immediate results 30 min after the procedure. Follow-up evaluation was performed with color flow mapping at 24 h, 1 month, 3 months, 6 months and 1 year after closure. RESULTS： The devices were successfully placed in 152 patients （with the exception of four patients due to obstructive pulmonary hypertension）. Thirty minutes after closure, systolic pulmonary pressure in the successful cases decreased from （48.2±22.6） to （35.6±12.4） mmHg （P〈0.05）, the mean pulmonary pressure decreased from （40.2±14.5） mmHg to （27.2±10.7） mmHg （P〈0.05） and aortic pressure increased from （102.2±12.6） to （106.6±13.8） mmHg （P〉0.05）. Complete angiographic closure was seen 30 min after placement of device in 119/152 patients （78.3%）, whereas small leaks were observed in 33 cases （21.7%）. Complete echocardiographic closure was observed in 147/152 successful cases （96.7%） within 24 h and 100% at 1-month follow-up in all patients. There was no PDA recanalization, migration of devices or other complications after complete occlusion during 1-12 months of follow up. CONCLUSION： Catheter closure of adult PDA using Chinese-made mushroom-shape occluder is a safe and effective method used before the occurrence of obstructive pulmonary hypertension.

关 键 词：成人 动脉导管未闭 介入治疗 国产蘑菇伞 

分 类 号：R654.2[医药卫生—外科学]