经胸室间隔缺损封堵术治疗三岁以下婴幼儿干下型室间隔缺损的临床疗效分析  

Clinical effect of transthoracic ventricular septal defect occlusion in treatment of subarterial ventricular septal defect in children aged <3 years

作　　者：叶仕高[1] 吴文绪[1] 郑晓宇[1] 陈文 石俊杰[1] 刘永春[1] YE Shi-gao;WU Wen-xu;ZHENG Xiao-yu;CHEN Wen;SHI Jun-jie;LIU Yong-chun(Nanjing First People's Hospital, Nanning 530022, China)

机构地区：[1]广西南宁市第一人民医院,广西南宁530022

出　　处：《心血管病防治知识（学术版）》2019年第3期60-62,共3页Prevention and Treatment of Cardiovascular Disease

摘　　要：目的探讨三岁以下婴幼儿的干下型室间隔缺损(VSD)行经胸室间隔缺损封堵术的临床疗效。方法对2015年5月至2018年5月我院收治的40例三岁以下干下型VSD的患儿病例资料回顾性分析,依据手术方式将其分在经胸室间隔缺损封堵组(A组)和CPB直视修补组(B组)。分别对其手术成功率、术中术后的情况及并发症等进行比较,进行统计分析。结果 B组的手术时间、机械通气、术后ICU和住院时间等方面均长于A组,输血量多于A组,差异有统计学意义(P<0.05)。缺损直径≤5mm时,两种术式的成功率均为100.00%;缺损直径在5～10mm之间时,B组的成功率为100.00%,略高于A组的88.89%,差异不显著(P>0.05)。两组术后早期各并发症的差异均无统计学意义(P>0.05),但A组的总发生率为25.00%,明显低于B组的50.00%,差异有统计学意义(P<0.05)。结论 VSD的直径对不同手术的成功率有影响。CPB直视修补的术后并发症发生率较经胸室间隔缺损封堵组高,后者在直径小于5mm的VSD中优势明显,前者在直径较大的VSD中优势明显。Objective To investigate the clinical effect of transthoracic ventricular septal defect(VSD) occlusion in the treatment of subarterial VSD in children aged <3 years. Methods A retrospective analysis was performed for the clinical data of 40 children(aged <3 years) with subarterial VSD who were admitted to our hospital from May 2015 to May 2018, and according to the surgical procedure, they were divided into group A(treated with transthoracic VSD occlusion) and group B(treated with direct-view repair using cardiopulmonary bypass). The two groups were compared in terms of success rate of surgery, intraoperative and postoperative conditions, and complications, and a statistical analysis was also performed. Results Compared with group A, group B had significantly longer time of operation, duration of mechanical ventilation, length of ICU stay after surgery, and length of hospital stay and a significantly higher volume of blood transfusion(P<0.05). When the defect diameter was ≤5 mm, the success rate of the two surgical procedures was100.00%;when the defect diameter was 5-10 mm, group B had a slightly higher success rate than group A(100.00% vs88.89%, P>0.05). There were no significant differences in early postoperative complications between the two groups(P>0.05), but group A had a significantly lower overall incidence rate of complications than group B(25.00% vs 50.00%, P<0.05). Conclusion VSD diameter may affect the success rate of different surgical procedures. Patients undergoing direct-view repair using cardiopulmonary bypass have a higher incidence rate of postoperative complications than those undergoing transthoracic VSD occlusion. Transthoracic VSD occlusion has a significant advantage in VSD with a diameter of <5 mm, while direct-view repair using cardiopulmonary bypass has a significant advantage in VSD with a larger diameter.

关 键 词：室间隔缺损 干下型 微创封堵术 非体外循环 

分 类 号：R725.4[医药卫生—儿科]