常见先天性心脏病介入治疗心肌损伤的影响因素分析  

Influencing factors of myocardial damage in congenital heart disease interventional treatment

作　　者：王珍全[1] 金佳蕙 夏天和[1] 任跃[1] 荣星[1] 仇慧仙[1] 张松跃[1] 吴蓉洲[1] 陈其[1] 

机构地区：[1]温州医科大学附属育英儿童医院心血管科,325000

出　　处：《浙江医学》2013年第24期2182-2185,共4页Zhejiang Medical Journal

摘　　要：目的研究经导管介入治疗不同类型先天性心脏病(CHD)过程中引起心肌损伤的影响因素。方法介入治疗的患者200例,根据类型分室间隔缺损(VSD组,61例)、房间隔缺损(ASD组,69例)、动脉导管未闭(PDA组,55例)、肺动脉瓣狭窄(PS组,15例);先天性心脏病造影的病例17例(造影组)。所有患者于术前及术后6h、24 h抽取静脉血检测心肌肌钙蛋白I(cTnl)含量,比较各组cTnl水平。根据cTnl的高低判断心肌损伤的严重程度,并采用单因素及Iogistic多因素回归分析各危险因素与心肌损害的关系。结果217例患儿中,术后cTnl升高159例,正常58例。单因素分析发现心肌损伤与年龄、体重、肺动脉压力、手术时间、封堵器大小、封堵器释放(或球囊扩张)次数及对比剂剂量有关(P<0.01或0.05)。Iogistic回归分析发现手术时间、封堵器大小、封堵器释放次数、对比剂剂量、体重是心肌损伤的独立危险因素。结论手术时间、封堵器大小、封堵器释放次数、对比剂剂量、体重可能是影响CHD介入治疗心肌损伤程度的重要因素。Objective To explore the influence factors of myocardial damage in the process of transcatheter therapy of congenital heart disease. Methods Transcatheter intervention of 200 cases of congenital heart disease were performed, includ- ing 61 cases of Ventricular septal defect（Group VSD）, 69 cases of Atrial septal defect（Group ASD）, 55 cases of Patent ductus ar- teriosus（Group PDA） and 15 cases of Pulmonary stenosis（Group PS）. There were 17 cases of congenital heart disease angiogra- phy（Group angiography）. The level of cTnl was measured by CLIA method before and 6h, 24h after operation, and the risk fac- tors of myocardial damage were analysed with single factor analysis and Logistic regression. Results The level of cTnl in- creased after operation in 159 cases, while remained normal in another 58 cases. Single factor analysis indicated that the my- ocardial damage was correlated with age of patient, body weight, pulmonary artery pressure, operation time, the size of the oc- cluder, the occluder release time and dose of contrast medium （P〈0.01 or 0.05）. Logistic regression showed that body weight, operation time, the size of the occluder, the occluder release time and dose of contrast medium were independent risk factors of myocardial damage. Conclusion Body weight, operation time, the size of the occluder, the occluder release time and dose of contrast medium may be important influence factors of myocardial damage in the process of transcatheter therapy of congenital heart disease.

关 键 词：介入治疗 先天性心脏病 微小心肌损伤 肌钙蛋白Ⅰ 

分 类 号：R654.2[医药卫生—外科学]