超声监护下国产器材封堵房间隔缺损的心导管法与经胸小切口法对比分析  

Comparative study between cardiac catheterization intervention therapy and transthoracic small incision surgery for closure of congenital atrial septal defect by domestic occluder with echocardiographic monitoring

作　　者：何小梅[1] 赵丽娜[2] 郭学佳[1] 张宁[1] 孙玉娜[1] 王军[3] 王震[4] 刘改芹[1] 

机构地区：[1]河北医科大学第一医院心脏超声科,石家庄050031 [2]香港大学深圳医院心血管内科,深圳518053 [3]河北医科大学第一医院心血管外科,石家庄050031 [4]河北医科大学第一医院心血管内科,石家庄050031

出　　处：《中南大学学报（医学版）》2017年第6期629-634,共6页Journal of Central South University ：Medical Science

基　　金：河北省医学科学研究重点课题(ZL20140061)~~

摘　　要：目的:评价超声心动图引导下采用国产器材在封堵房间隔缺损(atrial septal defect,ASD)时心导管法及经胸小切口法两种介入术式的安全性。方法:回顾性分析成功采用国产器材封堵ASD共1 080例,其中心导管法734例,经胸小切口法346例。心导管法术中是在导管室用大型数字减影血管造影机引导下,并结合经胸超声心动图(transthoracic echocardiography,TTE)监测整个封堵过程,以TTE评价疗效。经胸小切口法在手术室完全使用经食管超声心动图(transesophageal echocardiography,TEE)引导整个封堵过程,指导放置封堵器,并即刻评价疗效。结果:两种介入术式中用国产器材封堵ASD均能取得满意疗效,两种介入术式比较,缺损最长径大小差异无统计学意义(P>0.05),ASD/房间隔长度、封堵器大小、封堵器大小与ASD最长径的差值差异均有统计学意义(均P<0.05)。当ASD算术平均数<30 mm时,两种介入术式封堵成功率均为100%;当ASD算术平均数≥30 mm时,经胸小切口法封堵成功率为100%,心导管法封堵成功率为50%。结论:国产器材封堵安全,成本低。对于同样大小的缺损,经胸小切口法选择的封堵器较小,更合适。当ASD算术平均数≥30 mm时,经胸小切口法成功率比心导管法大,心导管法失败者可转为经胸小切口法。Objective：To evaluate the safety of cardiac catheterization intervention therapy and transthoracic small incision surgery in the occlusion bydomestic occluder under echocardiography guiding in patients with atrial septal defect（ASD）.Methods：A total of 1 080 patients with ASD in the occlusion by domestic occluder were analyzed retrospectively,and the interventional treatment were performed in 734 cases through cardiac catheterization intervention therapy and 346 cases through transthoracic small incision surgery.The patients undergone cardiac catheterization intervention therapy were guided under the digital substraction angiography（DSA） and were monitored by transthoracic echocardiography（TTE） in the whole interventional process,and the efficacy was evaluated with TTE.The occlusion of transthoracic small incision surgery was guided under the transesophageal echocardiography（TEE）,which was used to monitor the position of occluder and evaluate the efficacy immediately.Results：Two kinds of intervention in the occlusion by domestic occluder had achieved satisfactory results in patients with ASD.There was no statistically difference in the longest size of ASD between the 2 intervention methods,while there were statistically differences in the ratio between ASD longest diameter and atrial septal length,and the size of the occlusion,and the disparity between the size of the occluder and ASD longest diameter（D value）,respectively（all P〈0.05）.When the size of arithmetic mean of the ASD was 30 mm,the success rate of the 2 methods was both 100%.When the size of arithmetic mean of the ASD was ≥30 mm,the success rate was 100% in the transthoracic small incision surgery and 50% in the cardiac catheterization intervention therapy.Conclusion：Domestic occluder is safe.Compared with the imported one,its cost is lower.When the size of the defects is same,the occlusion is smaller in the transthoracic small incision surgery compared with that in the cardiac catheterization intervention therapy.When

关 键 词：超声心动图 国产封堵器 安全性 心导管法 经胸小切口法 介入治疗 房间隔缺损 

分 类 号：R540.45[医药卫生—心血管疾病] R541.1[医药卫生—内科学]