介入封堵术对巨大房间隔缺损患者心脏重塑的影响  

Clinical study of effect of interventional closure on cardiac remodeling in patients with giant atrial septal defects

作　　者：和旭梅[1] 杜亚娟[1] 邵珲 张松林[1] 闫丹丹 吝妮妮 霍晓薇[1] 张玉顺[1] He Xumei;Du Yajuan;Shao Hui;Zhang Songlin;Yan Dandan;Lin Nini;Huo Xiaowei;Zhang Yushun(Department of Structural Heart Diseases,First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院结构性心脏病科,陕西西安710061

出　　处：《中国医刊》2022年第4期402-405,共4页Chinese Journal of Medicine

基　　金：陕西省重点研发计划(2020ZDLSF04-14)。

摘　　要：目的探讨巨大房间隔缺损(atrial septal defect,ASD)患者介入封堵治疗后的心脏重塑情况。方法选取2012年10月至2017年11月在西安交通大学第一附属医院接受介入封堵术的137例巨大ASD患者,根据术前是否并发心房颤动(简称房颤)分为房颤组(28例)和非房颤组(109例)。两组均使用国产ASD封堵器治疗并随访观察6个月,所有患者在术后第3天和6个月进行经胸超声心动图、心电图检查,观察封堵效果、心脏大小、肺动脉压及心律失常发生情况。结果经胸超声心动图检查显示,术后第3天房颤组和非房颤组ASD堵闭完全率分别为82.14%、85.32%,而术后6个月时分别为100.00%、99.08%,组间比较差异均无显著性(P>0.05)。房颤组患者右心房左右径、右心室左右径、右心室前后径和肺动脉收缩压手术前后比较差异无显著性(P>0.05),而术后6个月时左心房左右径明显高于术前(P<0.05)。非房颤组术后第3天和6个月时右心房左右径、右心室左右径、右心室前后径和肺动脉收缩压明显低于术前,且术后6个月时明显低于术后第3天,差异均有显著性(P<0.05),而左心房左右径手术前后比较差异无显著性(P>0.05)。两组患者术前均出现右心肥大,术后6个月时非房颤组有98例(89.91%)患者右心恢复正常,而房颤组无一例患者右心恢复正常。随访至术后6个月,非房颤组新发生房性心律失常26例,而房颤组28例心电图均示仍为持续房颤。结论巨大ASD介入治疗安全、有效,纠正ASD可明显改善非房颤患者的心脏结构,但对房颤患者的作用仍需进一步随访观察。Objective To study changes of cardiac remodeling in patients with large atrial septal defect(ASD)before and after interventional treatment.Method From October 2012 to November 2017,a total of 137 patients with giant ASD were enrolled in this study,which were divided into atrial-fibrillation group(AF group,n=28)and non-atrial-fibrillation group(non-AF group,n=109).All patients were treated with domestic ASD occluder and followed up for 6 months.TTE and ECG were performed at 3 days and 6 months after operation.Cardiac size,pulmonary arterial pressure and arrhythmia were observed.Result TTE examination showed that the ASD completion rates of AF group and non-AF group were 82.14%and 85.32%respectively on the third day after surgery,while they were 100.00%and 99.08%respectively in the 6th month after surgery.There was no significant difference in the ASD completion rate in both groups on the 3rd day and in the 6th month after surgery(P>0.05).In non-AF group,the left and right diameters of RA,RV,anterior and posterior diameters of RV and PA systolic blood pressure were significantly decreased on the 3rd day after operation(P<0.05),and the above indexes were significantly decreased in the 6th month after operation,compared with those on the 3rd day after surgery(P<0.05),but the left and right diameters of LA were not significant different on the 3rd day after operation and in 6th month after operation compared with those before surgery(P>0.05).There was no significant difference in RA diameter,RV diameter,RV antero-posterior diameter and PA systolic blood pressure on the 3rd days an in the 6th month after operation between the two groups(P>0.05).LA diameter increased significantly in the 6th month after operation(P<0.05).Right heart hypertrophy was observed in both non-AF group and AF group before surgery.98(89.91%)patients with non-AF returned to normal right heart,while no patients with AF returned to normal right heart in the 6th month after surgery.A total of 26 patients with new-onset atrial arrhythmia in non-atria

关 键 词：房间隔缺损 封堵器 介入治疗 心脏重塑 

分 类 号：R654.2[医药卫生—外科学]