合并重度三尖瓣反流的室间隔缺损经皮介入手术可行性分析  

Feasibility study of transcatheter occlusion to ventricular septal defect companied with tricuspid insufficiency

作　　者：沈群山[1] 张刚成[1] 尚小珂[1] 聂林[1] 宋艳清[1] 刘洋[1] 卢蓉[1] 王利军[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,湖北省武汉市430022

出　　处：《中国心血管病研究》2015年第2期160-163,192,共5页Chinese Journal of Cardiovascular Research

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

摘　　要：目的 研究介入封堵术对重度三尖瓣反流的室间隔缺损的治疗效果.方法 选取2012年3月至2014年7月在我院确诊为重度三尖瓣反流的室间隔缺损患者16例,随机分为2组,其中导管介入组6例,外科手术组10例.三尖瓣反流的原因为右室局部心腔压力增高所致的高压血流直接冲击三尖瓣及其腱索而致.比较两组患者术后三尖瓣反流程度（三尖瓣反流长度、三尖瓣反流面积、三尖瓣反流容积、三尖瓣反流速度、三尖瓣反流压差）、手术时间、手术成功率、并发症发生率、术后住院时间、住院总费用、正性肌力药物评分、术后24h白细胞计数、C反应蛋白（CRP）、心肌损伤标志物（cTnI、CK-MB、MYO）.结果 术后三尖瓣反流量较术前显著减少,两组术后的三尖瓣反流程度未见统计学差异.导管介入组在手术时间[（55.1±9.3）min比（28.6±8.8）min]、术后血管活性药物、术后24 h白细胞计数[（16.5±7.9）×10^9/L比（8.5±3.2）×10^9/L]、C反应蛋白[（35.3±10.1）mg/L比（11.9±10.0）mg/L]、心肌损伤标记物等方面均优于外科手术组.结论 术前经超声评估,部分室间隔缺损合并三尖瓣重度反流患者行介入治疗优于外科手术.Objective Assessment of the effectiveness in patients with pelimembranous ventricular septal defect（VSD ） companied with tricuspid valve insufficiency（TI） treated with the VSD occluder or surgery. Methods Select 16 patients with VSD companied with TI who were treated in Wuhan Asia Heart Hospital, from 2012,3 to 2014,7. The cause of tricuspid regurgitation and right chambers of the heart chamber partial pressure increased due to the direct impact of the tricuspid valve and high pressure of blood flow caused by the tricuspid valve chordae reflux, randomly divided into 2 groups, line catheter interventional 6 cases, 10 cases of surgical repair surgery. The degree of postoperative tricuspid regurgitation （tricuspid regurgitation length, area of tricuspid regurgi- tation, tricuspid regurgitation volume, tricuspid regurgitation velocity, tricuspid regurgitation pressure）, success rate, complication rate, postoperative hospital stay, the total cost of hospitalization, surgery time [（55.1±9.3）min vs （ 28.6±8.8 ） min ], inotropic score after the first 24 h leukocyte count [ （ 16.5±7.9 ）×10^9/L vs （ 8.5±3.2 ）×10^9/L, CRP[（35.3±10.1）mg/L vs （11.9±10.0）mg/L], markers of myocardial injury（eTNI, CK-MB, MYO）were compared between two groups. Results No statistically significant difference in tricuspid regurgitation between two groups. The operative time, postoperative vasoaetive drugs, 24 h after the first white blood cell count, CRP and markers of myocardial injury were better in Catheter intervention group than the surgical group. Conclusion In some patients with ventricular septal defect associated with severe tricuspid regurgitation, screening by periopera- tive ultrasound carefully, the interventional treatment may be better than surgery.

关 键 词：三尖瓣反流 室间隔缺损 介入封堵 外科手术 

分 类 号：R654.2[医药卫生—外科学]