介入治疗小儿动脉导管未闭合并肺动脉高压27例疗效分析  

Curative effects of interventional treatment on 27 cases with patent ductus arteriosus complicated by pulmonary hypertension in children

作　　者：梁芳[1] 张翠媛[1] Liang Fang;Zhang Cuiyuan(Department of Pediatric,Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]广东省江门市中心医院儿内科,529000

出　　处：《中国实用医刊》2018年第15期50-52,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨介入封堵治疗小儿动脉导管未闭（PDA）合并肺动脉高压（PAH）的疗效.方法 回顾性分析经导管介入治疗小儿PDA合并PAH 27例患儿的临床资料.常规左右心导管检查,测肺动脉压力及主动脉压,在主动脉弓降部造影,观察动脉导管大小形态,采用国产蘑菇伞封堵器介入疗法,封堵成功后再测肺动脉及降主动脉压力.术后3 d、1个月、6个月复查超声心动图,监测封堵器形态、肺动脉压等指标.结果 27例患儿均封堵成功,痊愈出院,随访6个月未出现相关并发症.术前平均肺动脉收缩压（49.4±17.2）mmHg（1 mmHg=0.133 kPa）,其中轻度升高8例,中度升高18例,重度升高1例;封堵术后10 min肺动脉收缩压降低,平均（27.8±5.9）mmHg,与术前比较差异有统计学意义（P〈0.01）;术后1个月肺动脉收缩压均恢复至正常.降主动脉压封堵前后比较差异未见统计学意义（P〉0.05）.结论 经导管介入封堵治疗PDA合并PAH轻中度升高患儿肺动脉压明显下降,临床疗效显著.Objective To investigate the therapeutic effects of interventional closure on patent ductus arteriosus （PDA） with pulmonary hypertension （PAH）. Methods The clinical data of 27 children with PDA and PAH were analyzed retrospectively. Left and right cardiac catheterization were complemented, and pulmonary artery pressure and aortic pressure were measured. The size of the ducts was observed by radiography in descending part of the aortic arch. And homemade nitinol occluder was used for intervention treatment. After successful occlusion, pulmonary artery and descending aortic pressure were measured again. Eehocardiography was performed at 3 days, 1 month and 6 months after operation to monitor the shape of occluder and pulmonary artery pressure. Results All of the 27 children were successfully occluded, after 6 months of follow-up, no related complication was found. The mean pulmo- nary artery systolic pressure was （49.4 ± 17.2） mmHg （ 1 mmHg =0. 133 kPa） before operation, mildly increased in 8 cases, moderately increased in 18 cases, and severely increased in 1 case; the pulmonary artery systolic pressure decreased at 10 minutes after closure, the mean value was （27.8 ±5.9） mmHg, which was significantly lower than that before operation（ P 〈0.01 ） ; and the systolic pressure of pulmonary artery returned to normal level at 1 month after treatment. But there was no significant difference in descending aortic pressure before and after the closure （ P 〉 0. 05 ）. Conclusions Pulmonary artery pressure in children with PDA combined with mildly to moderatly increased PAH are decreased obviously after transcatheter closure, and the clinical efficacy are significant and safe.

关 键 词：动脉导管未闭 肺动脉高压 介入封堵治疗 

分 类 号：R725.4[医药卫生—儿科]