经皮球囊瓣膜成形术治疗230例儿童肺动脉瓣狭窄的长期随访  

Long-term follow - up of percutaneous balloon pulmonary valvuloplasty in pulmonary valve stenosis in 230 children

作　　者：孟霞[1] 韩波[1] 张建军[1] 王玉林[1] 赵立健[1] 伊迎春[1] 朱梅[2] 梁皓[2] 庄建新[1] 姜殿东[1] 吕建利[1] 王静[1] 

机构地区：[1]山东大学附属省立医院小儿心脏科,济南250021 [2]山东大学附属省立医院超声科,济南250021

出　　处：《中华实用儿科临床杂志》2018年第1期46-50,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：山东省重点研发计划（2016GSF201101）

摘　　要：目的评估经皮球囊肺动脉瓣成形术（PBPV）治疗儿童肺动脉瓣狭窄（PS）的安全性及有效性，观察术后长期预后，并分析其影响因素。方法选取山东大学附属省立医院小儿心脏科1987年11月至2015年11月230例行PBPV治疗的Ps患儿，年龄4个月～17岁，随访时间1—29年，收集患儿住院临床资料及门诊长期随访资料、同期健康同龄人超声心动图资料，并进行统计学分析。结果230例患儿中228例（99％）成功行PBPV，跨肺动脉瓣压差（△P）术前、术后24h、术后6个月、术后2年、术后5年及术后10年以上分别为（63．5±23．8）mmHg（1mmHg=0．133kPa）、（26．2±11．1）mmHg、（24．8±9．8）mmHg、（20．9±8．9）mmHg、（18．1±8．7）mmHg和（15．3±7．3）mmHg，术后即刻△P较术前明显下降，差异有统计学意义（P〈0．01）。在长期随访过程中大部分患儿△P可进一步下降，Logistic回归分析结果显示瓣膜发育不良型或伴右心室流出道狭窄、术后即刻残余AP程度为PBPV术后患儿中远期疗效不能达到优标准（≤25mmHg）的危险因素，随访10年以上患儿再狭窄率为4．6％（3／65例）；术后长期肺动脉瓣反流发生率（83％）较术前（58％）、术后24h（68％）均明显增高，且反流程度加重，差异有统计学意义（P〈0．05），而三尖瓣反流程度在随访过程中逐渐减轻，差异有统计学意义（P〈0．05）；随访10年以上的患儿右心室舒张期内径[（19．27±3．03）mm]较同期健康同龄人[（15．24±2．89）mm]偏大，差异有统计学意义（P〈0．05）。结论PBPV治疗PS患儿中远期疗效良好，严重并发症少，再狭窄率低，可作为PS的首选治疗方法，但术后长期肺动脉瓣反流发生率及程度有增加趋势，右心室舒张期内径仍偏大，需引起重视，注重院外长期随访监测。Objective To evaluate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty （PBPV） in the treatment of the children with pulmonary stenosis （PS）,and to observe the long- term prognosis and analyze the influencing factors. Methods The total of 230 children were collected, who had been diagnosed with pul- monary valve stenosis and had undergone percutaneous balloon pulmonary valvuloplasty between November 1987 and November 2015 in Shandong Provincial Hospital Affiliated to Shandong University. Their ages ranged from 4 months to 17 years, and the follow -up duration lasted from 1 month to 29 years. The data included clinical data and long -term follow - up data of hospitalized children,and the echocardiography data from the healthy peers in the same period. Then the data were analyzed statistically. Results In this study,228 cases of children were successfully performed PBPV, and the success rate was 99% （228/230 cases）. The pulmonary transvalvular gradient （AP） of preoperation,24 hours postoperatively, half a year postoperatively,2 years postoperatively,5 years postoperatively, and 10 years postope-rafively was （63.5 ±23.8） mmHg（1 mmHg =0. 133 kPa）, （26.2 ±11. 1） mmHg, （24.8±9.8） mmHg, （20.9 ± 8.9） mmI-Ig, （ 18.1 ± 8.7 ） mmHg, （ 15.3 ± 7.3 ） mmHg and （ 15.3 ± 7.3 ） mmHg, respectively. The immediate post- operative △ P was significantly lower than that of preoperation （P 〈 0.01 ）, and the A P of the most children decreased in the long - term follow - up. The results of Logistic regression analysis showed that valve dysplasia with right ventricu- lar outflow tract stenosis and the immediate postoperative residual transvalvular gradient degree were the risk factors for long term curative effect of PBPV in children who could not reach the best standard. The restenosis rate was 4.6% （3/ 65 cases） with children followed up for more than 10 years. The incidence of long - term follow - up pulmonary valve regurgitation （83%） was signifi

关 键 词：经皮球囊肺动脉瓣成形术 肺动脉瓣狭窄 儿童 随访 

分 类 号：R726.5[医药卫生—儿科]