单纯食管超声引导下经股静脉行动脉导管未闭封堵术的安全性和有效性  

Safety and efficacy of percutaneous patent ductus arteriosus closure via femoral vein under transesophageal echocardiography guidance

作　　者：卢绪宁[1] 文平[1] 刘启龙[1] 刘宇航[1] 赵烨[1] 于生喜[1] 朱全伟[1] 

机构地区：[1]大连医科大学附属大连市儿童医院心脏中心,116012

出　　处：《中华实用儿科临床杂志》2017年第1期41-43,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨单纯食管超声引导下经股静脉行动脉导管未闭（PDA）封堵术的安全性和有效性。方法选取大连医科大学附属大连市儿童医院2014年5月至2015年5月单纯食管超声引导下经股静脉行PDA封堵术的单纯PDA患者28例，其中男13例，女15例；年龄（3.5±2.6）岁；体质量（16.0±6.5） kg；PDA直径（7.1±3.9） mm。患者均在食管超声心动图引导下经股静脉行PDA封堵术，封堵后即刻以食管超声评价治疗效果。术后1个月、3个月和6个月门诊随访经胸超声心动图、X线胸片及心电图。结果27例患者均在单纯食管超声引导下经股静脉成功完成PDA封堵术，1例患者PDA伞误入左肺动脉，术后1个月复查时发现，改为开胸并行体外循环下结扎PDA，并成功取出封堵器。手术操作时间为（48.5±8.7） min，PDA蘑菇型封堵器的直径为（8.2±4.1） mm。除1例行外科手术关闭，其余患者无外周大血管损伤、残余分流、心律失常及心肌损伤等并发症。住院时间为（2.5±0.5） d。术后1个月随访无残余分流、心包积液等并发症。结论单纯食管超声引导下经股静脉行PDA封堵术安全、有效，能避免使用X线和对比剂的损伤，无需股动脉穿刺。Objective To investigate the efficacy and safety of percutaneous patent ductus arteriosus （PDA） closure via femoral vein solely under transesophageal eehocardiography guidance. Methods From May 2014 to May 2015,28 patients（ 13 boys, 15 girls） were selected in Dalian Children＇s Hospital Affiliated to Dalian Medical University with PDA closure via the femoral vein under transesophageal eehocardiography guidance, with mean age （ 3.5 ±2.6 ） years and mean body weight （ 16.0 ±6. 5 ） kg. The mean diameter of PDA was （7.1 ±3.9 ） mm. Patients were all trea- ted by percutaneous PDA closure solely by transesophageal echoeardiagraphy via the femoral vein. The effect of the procedures was evaluated by eehocardiography. The transthoracie echocardiography, chest X - ray film, cardiogram at 1 month,3 months and 6 months after procedure were followed up. Results Twenty - seven cases were successfully trea- ted with pereutaneous PDA closure via the femoral vein solely under transesophageal eehoeardiography guidance, while 1 patient was closed by surgical closure with on - pump beating - heart because PDA oceluder strayed into the left pulmonary artery on 1 - month follow - up. The procedural time was （48.5 ±8.7） min. The mean diameter of PDA occlu- der was （ 8.2 ± 4.1 ） mm. Twenty - seven patients survived without peripheral vascular injury or complications such as residual shunt, arrhythmia and cardiac perforation. One patient was transformed to surgical closure. Hospitalization time was （2.5 ± 0.5 ） days. At one month follow - up, no complications such as residual shunt or pericardial effusion occurred. Conclusion Transesophageal echocardiography guided pereutaneous PDA closure via the femoral vein approach is safe and effective without the damage from radiation and contrast agents, and aviods the use of femoral artery puncture.

关 键 词：动脉导管未闭 心脏导管插入术 食管超声 

分 类 号：R725.4[医药卫生—儿科]