介入封堵器治疗婴幼儿动脉导管未闭54例疗效观察  

Interventional occluder for patent ductus arteriosus in 54 children

作　　者：赵胜[1] 黄晓碧[1] 祁晓慧 郑丽云[1] ZHAO Sheng;HUANG Xiaobi;QI Xiaohui;ZHENG Liyun(Department of Cardiology,Anhui Provincial Children＇s Hospital,Children＇s Hospital of Anhui Medical University,He f ei 230051,China)

机构地区：[1]安徽省儿童医院安徽医科大学附属省儿童医院心内科,合肥230051

出　　处：《中华实用诊断与治疗杂志》2018年第10期988-991,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：安徽省卫生计生委科研计划项目(2017ek004)

摘　　要：目的观察婴儿期动脉导管未闭(patent ductus arteriosus,PDA)介入治疗效果、并发症发生情况和对血流动力学的影响。方法行封堵器介入治疗的PDA患儿54例,于治疗前及治疗后3d及1、6个月经胸超声心动图检查各瓣膜功能情况,封堵器封堵效果,左心室血流动力学指标等。结果 54例患儿均成功植入封堵器;7例术后3d超声检查显示有残余分流,其中1例中量残余分流和1例少量分流者随访中呈减轻趋势,另5例少量残余分流6个月内消失;术后3d超声检查发现三尖瓣腱索断裂2例,并造成三尖瓣重度和中度反流;左心室舒张末期内径术后3d[(3.10±0.44)cm]、1个月[(2.93±0.35)cm]、6个月[(2.97±0.26)cm]均较术前[(3.37±0.45)cm]明显减小,左心室收缩末期内径术后1个月[(1.90±0.29)cm]、6个月[(1.83±0.23)cm]较术前[(2.05±0.34)cm]明显减小(P<0.01),术后3d左室射血分数[(60.88±7.25)%]和左心室缩短分数[(31.61±5.42)%]均明显低于术前[(70.39±5.79)%,(39.05±4.65)%](P<0.01),6个月左室射血分数和缩短分数[(69.71±6.25)%,(37.95±5.57)%]与术前比较差异均无统计学意义(P>0.05)。结论婴儿期PDA介入治疗安全、有效,但有可能出现三尖瓣腱索断裂和残余分流等并发症及左室收缩功能暂时性降低。Objective To observe the result and complication of interventional occlusion in the treatment of patent ductus arteriosus（PDA）in infants and its hemodynamic changes.Methods Fifty-four infants with PDA receiving interventional occlusion were observed the condition of the cardiac valve,the occlusion effects and the left ventricular hemodynamic indexes before operation,and 3 d,1 month and 6 months after operation by transthoracic echocardiography.Results The occluders were successfully implanted in all infants.Echocardiography showed residual shunt in 7 infants 3 d after operation,in which 1 with moderate residual shunt and 1 with slight shunt appeared a trend of reduction during follow-up,and the other 5 infants with small amount residual shunt disappeared within 6 months.Echocardiography also showed chordae tendineae rupture in 2 infants 3 d after operation resulting in severe and moderate tricuspid regurgitation.The left ventricular end-diastolic dimension was significantly shorter 3 d after operation（（3.10±0.44）cm）,1 month after operation（（2.93±0.35）cm）and 6 month after operation（（2.97±0.26）cm）than that before operation（（3.37±0.45）cm）（P〈0.05）.The left ventricular end-systolic dimension was significantly shorter 1 month after operation（（1.90±0.29）cm）and 6 months after operation（（1.83±0.23）cm）than that before operation（（2.05±0.34）cm）（P〈0.01）.The left ventricular ejection fraction and fractional shortening were significantly lower 3 d after operation（（60.88±7.25）%,（31.61±5.42）%）than those before operation（（70.39±5.79）%,（39.05±4.65）%）（P〈0.01）,and showed no significant differences 6 months after operation（（69.71±6.25）%,（37.95±5.57）%）in comparison with those before operation（P〉0.05）.ConclusionInterventional therapy is safe and effective for infants with PDA,but the complications as tricuspid chordae tendineae rupture,residual shunt and temporary reduction of left ventricular systolic fun

关 键 词：动脉导管未闭 介入封堵器 婴幼儿 左心室舒张末期内径 左心室收缩末期内径 

分 类 号：R725.4[医药卫生—儿科]