不同介入封堵入路治疗儿童(≤7岁)动脉导管未闭的临床疗效分析  

Clinical efficacy analysis of different interventional approaches for patent ductus arteriosus in children(≤7 years)

作　　者：周泽明 王宏茂[2] 郑宏[1] 宋会军[1] 李世国[1] 闫朝武[1] 胡海波[1] 刘琼[1] 徐仲英[1] 徐亮[1] 吕建华[1] 张戈军[1] 万俊义 金敬琳[1] ZHOU Zeming;WANG Hongmao;ZHENG Hong;SONG Huijun;LI Shiguo;YAN Chaowu;HU Haibo;LIU Qiong;XU Zhongying;XU Liang;LV Jianhua;ZHANG Gejun;WAN Junyi;JIN Jinglin(Department of Structural Heart Disease,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100037,P.R.China;Department of Cardiovascular Diseases,Children’s Hospital Affiliated to Capital Institute of Pediatrics,Beijing,100020,P.R.China)

机构地区：[1]中国医学科学院,北京协和医学院阜外医院结构性心脏病病区,北京100037 [2]首都儿科研究所附属儿童医院心血管内科,北京100020

出　　处：《中国胸心血管外科临床杂志》2023年第5期699-703,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划项目(2018YFB1107100)。

摘　　要：目的探索不同介入封堵入路治疗小儿动脉导管未闭(patent ductus arteriosus,PDA)的安全性及有效性。方法回顾性纳入2019—2020年阜外医院收治的≤7岁行介入治疗的PDA患者。根据不同介入封堵入路将患者分为3组,常规动静脉组、单纯静脉组和逆行股动脉组。比较患者的临床资料。结果共纳入220例患者,其中男78例、女142例,年龄(3.21±1.73)岁,体重(14.99±5.35)kg,身高(96.19±15.77)cm,平均PDA直径(3.35±1.34)mm。85例患者采用常规动静脉法,104例采用单纯静脉法,31例采用逆行股动脉法。逆行股动脉组PDA直径最小[(3.44±1.43)mm vs.(1.99±0.55)mm;(3.69±1.17)mm vs.(1.99±0.55)mm,P<0.001];单纯静脉组术中造影剂用量最少[40(30,50)mL vs.20(20,30)mL;35(25,50)mL vs.20(20,30)mL,P≤0.001],手术时间最短[32(26,44)min vs.25(23,30)min;29(25,38)min vs.25(23,30)min,P<0.05];常规动静脉组住院时间最长[3(3,5)d vs.4(3,6)d;4(3,5)d vs.4(3,6)d,P<0.05]。术后并发症差异无统计学意义(P>0.05)。结论单纯经静脉入路PDA封堵术安全有效;逆行股动脉入路对直径较小的PDA具有简化手术流程等优势。Objective To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus(PDA)in children.Methods The children(≤7 years)who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included.The patients were divided into 3 groups according to the procedures:a conventional arteriovenous approach group,a simple venous approach group,and a retrograde femoral artery approach group.The clinical efficacy of the patients was compared.Results A total of 220 patients were included.There were 78 males and 142 females,with an average age of 3.21±1.73 years,weight of 14.99±5.35 kg,and height of 96.19±15.77 cm.The average diameter of the PDA was 3.35±1.34 mm.A total of 85 patients received a conventional arteriovenous approach,104 patients received a simple venous approach,and 31 patients received a retrograde femoral artery approach.The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups(3.44±1.43 mm vs.1.99±0.55 mm;3.69±1.17 mm vs.1.99±0.55 mm,P<0.001);the contrast medium usage[40(30,50)mL vs.20(20,30)mL;35(25,50)mL vs.20(20,30)mL,P≤0.001]and operation time[32(26,44)min vs.25(23,30)min;29(25,38)min vs.25(23,30)min,P<0.05]in the simple venous approach group were significantly less or shorter than those in the other two groups;the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups[3(3,5)d vs.4(3,6)d;4(3,5)d vs.4(3,6)d,P<0.05].There was no significant difference in postoperative complications.Conclusion It is safe and effective to close PDA through simple venous approach.The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

关 键 词：动脉导管未闭 介入封堵 常规动静脉法 单纯静脉法 逆行股动脉法 

分 类 号：R725.4[医药卫生—儿科]