新型肺动脉带瓣支架Venus P植入围术期的监测与治疗  

Perioperative monitoring and treatment of a new pulmonary valved stent Venus P implantation

作　　者：吴开元[1] 张戈军 李斌[1] 宋书波[1] 韩宇[3] 刘琳[4] 梁栋[1] 赵力运 范太兵[1] 潘湘斌 WU Kaiyuan;ZHANG Gejun;LI Bin;SONG Shubo;HAN Yu;LIU Lin;LIANG Dong;ZHAO Liyun;FAN Taibing;PAN Xiangbin(Department ofChildrens Heart Center,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,450003,China;Department of Radiology,Fuwai Hospital,Chinese Academy of Medical Science;Department of Structural Heart Disease,Henan Provincial Peoples Hospital,Fuwai Central China Cardiovascular Hospital;Department of Ultrasound,Henan Provincial Peoples Hospital,Fuwai Central China Cardiovascular Hospital;Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Science)

机构地区：[1]河南省人民医院阜外华中心血管病医院儿童心脏中心,郑州450003 [2]中国医学科学院阜外医院放射科 [3]河南省人民医院阜外华中心血管病医院结构性心脏病病区 [4]河南省人民医院阜外华中心血管病医院超声科 [5]中国医学科学院阜外医院心脏外科

出　　处：《临床心血管病杂志》2020年第9期831-834,共4页Journal of Clinical Cardiology

基　　金：河南省医学科技攻关计划项目(No:201601023)。

摘　　要：目的:探讨Venus P自膨胀瓣膜系统经皮肺动脉瓣植入术(PPVI)的围术期观察与处理策略。方法:回顾性分析2017年12月-2019年12月阜外华中心血管病医院儿童心脏中心共13例法洛四联症矫治术后行PPVI的患者,探讨围术期的具体管理方法,并分析手术前后肺动脉瓣反流程度、三尖瓣反流程度、右心室前后径、右心室流出道直径、左心室射血分数、血脑钠肽(BNP)值、QRS波宽度的变化、术后机械通气时间和重症监护室滞留时间。结果:13例患者均成功植入Venus P瓣膜支架,无严重并发症,术后肺动脉瓣均为无反流或者微量反流,肺动脉瓣反流面积术后为0.30(0.00,0.85) cm2,与术前8.20(7.75,9.80) cm2比较,差异有统计学意义(Z=-4.373,P<0.01)。其他临床观察指标围术期手术前后变化差异均无统计学意义。结论:国产Venus P自膨胀瓣膜系统可安全有效解决法洛四联症跨瓣环补片矫治术后的肺动脉瓣重度反流、右心室流出道功能不全的问题,临床需要不断积累围术期观察与处理策略的经验,以增加手术的安全性,减少相关并发症的发生。Objective:To investigate the perioperative observation and treatment strategy of percutaneous pulmonary valve valve implantation(PPVI) for Venus P valve system.Method:We were retrospectively analyzed a total of 13 cases of tetralogy of fallot correctional line PPVI postoperative patients from December 2017 to December 2019,and discussed the specific perioperative management methods,the degree of pulmonary valve regurgitation before and after operation,the degree of tricuspid regurgitation,right ventricular diameter,the diameter of right ventricular outflow tract,before and after the left ventricular ejection fraction,blood BNP value,the change of QRS wave width,postoperative mechanical ventilation time and ICU retention time.Result:All the 13 patients were successfully implanted Venus P stent without serious complications.There was no or micro regurgitation of pulmonary valve postoperative.The pulmonary valve regurgitation area was 0.30(0.00,0.85) cm^2 after surgery,and the difference was statistically significant compared with 8.20(7.75,9.80) cm^2 before surgery(Z=-4.373,P<0.01).There was no significant difference in other clinical observation indexes before and after operation,P>0.05.Conclusion:The domestic Venus P self expanding valve system can safely and effectively solve the severe pulmonary valve regurgitation and right ventricular outflow tract dysfunction after transannular patch correction of tetralogy of Fallot.It is necessary to accumulate the experience of perioperative observation and management strategy to increase the safety of operation and reduce the related complications.

关 键 词：Venus P 经皮肺动脉瓣植入术 肺动脉瓣反流 右心室流出道功能不全 

分 类 号：R542.5[医药卫生—心血管疾病]