主-肺动脉途径导管参照法建立轨道的动脉导管未闭封堵治疗的临床研究  

Transcatheter closure treatment of patent ductus arteriosus with orbital construction by using reference of aorta-pulmonary artery catheter

作　　者：赵培欣 陈维 闫巧云 

机构地区：[1]上海远大心胸医院心内二科,上海200235

出　　处：《中国循证心血管医学杂志》2012年第4期351-353,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨主-肺动脉途径导管参照法建立轨道的动脉导管未闭(patent ductus arteriosus,PDA)封堵治疗的可行性与安全性。方法对203例PDA患者进行封堵治疗,其中建立轨道采用常规法155例,采用动静脉轨道逆向导丝法28例,主-肺动脉途径导管参照法20例。在用三种方法建立轨道前均通过主动脉弓降部以LAO90°或105°造影观察PDA的形状、最窄内径及术后分流情况,并作为选择封堵器大小的依据及即刻疗效评价手段,在术后24h,1个月,3个月进行心电图及胸部X片,超声随访封堵处有无分流,三尖瓣有无返流及肺动脉压力变化等。结果 203例患者均封堵成功,与常规建立轨道法及采用动静脉轨道逆向导丝建立轨道法相比,主-肺动脉途径导管参照法建立轨道的PDA封堵治疗的成功率,手术时间,术后超声随访结果均无统计字差异,且住院费用减少。结论主-肺动脉途径导管参照法建立轨道的动脉导管未闭封堵治疗具有可行性与较高的安全性,与逆向导丝法相比减少了住院费用,可试作为一种新的轨道建立法进行临床应用。Objective To investigate the feasibility and safety of transcatheter closure treatment of patent ductus arteriosus （PDA） with orbital construction by using reference of aorta-pulmonary artery catheter. Methods The PDA patients （n=203） were given transcatheter closure treatment, among them 155 were given routine orbital construction, 28, aorta-pulmonary orbital retrograde wire, and 20, reference of aorta-pulmonary artery catheter. Before orbital construction by three methods, the shape and smallest diameter of PDA and post-operative shunt were observed by angiography of descending part of aortic arch with LAO 90~ or 105~ , which also taken as the evidence for selecting oceluder and approach for reviewing immediate curative effect. After the operation for 24 hours, one month and 3 months, ECG, X-ray and echocardiography were used for following up the status of shunt in closure position, contraflow in tricuspid valve and pressure changes of pulmonary artery. Results All 203 patients had successful closure. Compared with routine orbital construction and aorta-pulmonary orbital retrograde wire, reference of aorta-pulmonary artery catheter had no significant difference in success rate, operation time and results of post-operative echocardiography follow-up, but had lower hospitalization costs. Conclusion Transcatheter closure treatment of PDA with orbital construction by using reference of aorta-pulmonary artery catheter is feasibility with higher safety and lower hospitalization costs, which can be used as a new method for orbital construction in clinic.

关 键 词：动脉导管未闭 封堵治疗 方法 轨道 

分 类 号：R541.1[医药卫生—心血管疾病]