三岁以下婴幼儿膜周部室间隔缺损介入封堵治疗的可行性研究  

Feasibility study of interventional treatment for membranous ventricular septal defect in infants less than three years of age

作　　者：尚小珂[1] 张刚成[1] 肖书娜[1] 柳梅[2] 丁珊珊[3] 

机构地区：[1]武汉亚洲心脏病医院,430022 [2]武汉市第一医院 [3]华中科技大学同济医学院附属协和医院

出　　处：《介入放射学杂志》2014年第8期658-662,共5页Journal of Interventional Radiology

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：目的探讨婴幼儿膜周部室间隔缺损(VSD)行介入封堵治疗的可行性和安全性。方法2012年1月—2013年1月收治3岁以内婴幼儿单纯膜周部VSD 229例,行经皮导管介入封堵术(介入组)88例,外科手术(手术组)141例。对比两组手术成功率、主要并发症及次要并发症发生率、手术时间、术后住院时间、术后肺部感染率、住院费用等指标。结果两组患者在手术成功率、主要并发症发生率、术后住院时间、住院费用方面差异无统计学意义(P>0.05)。介入组在次要并发症发生率、手术时间等方面明显优于手术组。手术组在次要并发症多为呼吸道感染及术后24 h白细胞计数、C反应蛋白、心肌损伤标志物水平、血管活性药物评分上显著高于介入组。结论 3岁以下婴幼儿膜周部VSD行经皮导管介入封堵术临床上可行,在严格把握手术指征、改良操作技术基础上,经皮导管介入封堵术策略安全可靠,优势明显,可部分替代外科手术。Objective To study the feasibility and safety of interventional closure for the treatment of infant’s perimembranous ventricle septal defect （PmVSD）. Methods During the period from Jan. 2012 to Jan. 2013, a total of 229 single PmVSD infants less than three years of age were admitted to authors ’ hospital. The infantile patients were divided into intervention group （n = 88） and surgery group （n = 141）. Patients in the intervention group underwent interventional closure procedure , while patients in the surgery group received conventional cardiac surgery. The operation success rate , the main and minor complication rates, the operation time, the postoperative hospitalization days, the incidence of postoperative pulmonary infection and the medical cost were recorded , and the results were compared between the two groups. Results No statistically significant differences in the operation success rate, the main complication rate, the postoperative hospitalization days and the medical cost existed between the two groups （P 〉 0.05）. But the minor complication rate and the operation time of the intervention group were better than those of the surgery group. In the surgery group, the minor complication was mainly the respiratory infection, which was manifested as higher leukocyte count, higher C-reactive protein level, higher myocardial damage marker level as well as higher vasoactive drug scores in 24 hours after the operation , and the above items were significantly higher than those in the intervention group. Conclusion For the treatment of infant’s perimembranous ventricle septal defect, percutaneous transcatheter closure is clinically feasible. This technique is safe and reliable with obvious advantages when the indication is strictly observed and the procedure is carefully manipulated. This treatment can partly replace the conventional＆amp;nbsp;surgery.

关 键 词：室间隔缺损 婴幼儿 介入封堵 外科手术 

分 类 号：R726.5[医药卫生—儿科]