室间隔缺损封堵术中的改良漂导丝技术  

Operating skills in preventing compliation in ventricular septal defect occluder

作　　者：尚小珂[1] 张刚成[1] 沈群山[1] 王利军[1] 姚艺[1] 李丁扬 肖书娜[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,430022

出　　处：《中国介入心脏病学杂志》2013年第6期358-361,共4页Chinese Journal of Interventional Cardiology

基　　金：湖北省卫生厅科研项目(JX6B90);武汉市卫生局科研项目(WX13C47)

摘　　要：目的探讨改良漂导丝技术在膜周型室间隔缺损(VSD)介入封堵中的使用操作技巧及价值。方法回顾分析2009年1月至2012年1月武汉亚洲心脏病医院行膜周型VSD介入封堵治疗的患者451例,按照术中是否使用改良漂导丝技术建立轨道分为A组(术中使用改良漂导丝技术建立轨道)和B组(使用传统技术建立轨道)。比较两种方式的手术时间、术中严重心律失常发生率、建立轨道成功率、总手术成功率及术后三尖瓣反流(TI)情况等。结果两组患者所使用的封堵器型号、类别差异无统计学意义。与B组相比,A组手术时间[(31.53±5.69)min比(42.65±10.77)min,P<0.01]短,心律失常发生率(11.6%比61.0%,P<0.01)和术后出现TI并发症发生率(0.7%比5.0%,P<0.01)较低,建立轨道成功率(99.3%比95.0%,P<0.01)与总成功率(98.3%比87.4%,P<0.01)较高。结论改良漂导丝技术并发症发生率低、效果可靠、更具实用性,在膜周型VSD介入封堵术中可以完全取代传统方式建立动-静脉轨道。Objective To discuss the operating skills and values of improved floating guidewire in Ventricular septal defect occluder. Methods Retrospectively analyze 451 patients including aged 1. 3- 55 years（ 7. 46 ± 3. 45）,247 male,204 female. who has acceptted ventricular septal defect occluder in our hospital from Jan. 2009 to Jan. 2012. All the patients were divided into two groups according to whether using improved floating guidewire or not. In Group A,improved fleating guidewire was used to establish the track but in Group B,traditional technology was used establish the track. Comparison in operative time,the incidence of arrhythmia,the success rate to establish the track,the total success rate of surgery and the incidence of postoperative tricuspid regurgitation was studied. Results There were no statistical difference about the occluder＇s size or type. Compared with group B,patients in group A using the improved floating guidewire needed shorter operation time（ 31. 53 ± 5. 69 mins vs. 42. 65 ± 10. 77 mins,P 0. 01）,lower rats of post operational arrhythmia（ 14. 3% vs. 33. 3%,P 0. 01） and tricuspid insufficiency（ TI）（ 0. 7% vs. 5. 0%,P 0. 01）. Group A also showed higher success rate in track establishment（ 99. 3% vs. 95. 0%,P 0. 01） and total success rate（ 98. 3% vs. 87. 4%,P 0. 01）. Conclusions The improved floating guidewire technology in ventricular septal defect occluder was safer,more effective and more practical in the establishment of arteriovenous track.

关 键 词：室间隔缺损 介入封堵 建立轨道 并发症 漂导丝 

分 类 号：R541.1[医药卫生—心血管疾病]