完全超声引导与放射线引导行经皮肺动脉瓣球囊成形术的对比研究  

Comparative Study Between Complete Ultrasound Guidance and Radiation Guidance in Percutaneous Balloon Pulmonary Valvuloplasty

作　　者：郭改丽[1] 刘倩倩[1] 欧阳文斌[1] 张凤文[1] 刘垚 邱旭[1] 赵广智[1] 邹孟轩 温彬 潘湘斌[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管外科,北京市100037

出　　处：《中国循环杂志》2017年第9期904-907,共4页Chinese Circulation Journal

基　　金：基金资助:首都临床特色应用研究(2016-BKJ03)

摘　　要：目的:通过与传统放射线引导方法相比较,评价完全超声引导下经皮肺动脉瓣球囊成形术(PBPV)的安全性和有效性。方法:收集我院2013-03至2016-08完全超声引导下行PBPV患者102例(超声组),同期传统放射线引导下行PBPV患者280例(放射线组)。两组患者术后均以超声心动图进行随访和评价治疗效果。结果:两组患者年龄、体重、肺动脉瓣环直径、术前肺动脉瓣跨瓣压差、球囊直径、术后即刻跨瓣压差、住院时间及住院费用差异均无统计学意义(P均>0.05)。超声组和放射线组手术成功率分别为99.0%和100%(P=0.267),超声组有1例患者因扩张后右心室流出道肌肉痉挛转为常规外科手术。放射线组术中操作时间(min)长于超声组(38.9±9.2比34.6±10.0,P<0.001),放射线组放射线时间为(3.9±1.2)min。术后门诊平均随访(25.5±13.2)个月,超声组和放射线组肺动脉瓣跨瓣压差(mm Hg,1 mm Hg=0.133 k Pa)分别为(16.2±4.3比15.3±4.5,P=0.120),两组患者均无死亡、外周血管损伤、心脏穿孔、心包积液等严重并发症。结论:完全超声引导下PBPV不仅能够完全避免放射线及对比剂,而且保持了传统经皮介入治疗微创、安全及疗效确切的优点。Objective： To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty （PBPV） in comparison with conventional X-ray guidance. Methods： Our research included in 2 groups： Ultrasound group, n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group, n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time. Post-operative effect was evaluated by echocardiography and compared between 2 groups. Results： The patients＇ age, body weight, pulmonary artery diameter, immediate post-operative pulmonary transvalvular pressure gradient （PTPG）, the in-hospital time and cost were similar between 2 groups, P〉0.05. The success rate of operation in Ultrasound group and X-ray group was 99.0% vs 100%, P=0.267. In the ultrasound group, 1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation. The operation time in X-ray group was longer than Ultrasound group, （38.9±9.2） min vs （34.6±10.0） min, P〈0.001. The X-ray exposure time was （3.9±1.2） min in X-ray group. The mean follow-up time was （25.5±13.2） months and PTPG in Ultrasound group and X-ray group were （16.2±4.3） mmHg and （15.3±4.5） mmHg, P=0.120. No serious complications as death, peripheral vascular injury, cardiac perforation and pericardial effusion occurred in either group. Conclusion： PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent, but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.

关 键 词：肺动脉瓣狭窄 超声心动描记术 心脏导管插入术 

分 类 号：R54[医药卫生—心血管疾病]