无造影单侧股静脉入路动脉导管未闭封堵术的初步临床应用  

Preliminary Clinical Application of Patent Ductus Arteriosus Closure Through Single Venous Approach Without Angiography Under Ultrasound Guidance

作　　者：贺一伟 胡海波 吕建华 叶粟 刘琼 HE Yiwei;HU Haibo;LYU Jianhua;YE Su;LIU Qiong(Department of Structural Heart Disease,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Suining Central Hospital,Suining 629000,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院结构性心脏病中心,北京100037 [2]遂宁市中心医院心血管外科,遂宁629000

出　　处：《中国循环杂志》2023年第5期515-519,共5页Chinese Circulation Journal

基　　金：中国医学科学院北京协和医学院重点特色课题基金(2018-F03)。

摘　　要：目的:初步探讨超声心动图监测下无造影单侧股静脉入路封堵治疗动脉导管未闭(PDA)的可行性及临床疗效。方法:共纳入2021年1月至2022年5月在中国医学科学院阜外医院接受介入治疗的73例PDA患者,其中超声心动图监测下无造影单侧股静脉入路PDA封堵37例(超声监测组),传统降主动脉造影下股动静脉入路PDA封堵36例(传统造影组)。比较两组手术成功率、射线剂量、术中对比剂用量、手术前后肌酐水平、手术前后尿酸氮水平、血管并发症发生率等指标。结果:两组年龄、性别构成差异无统计学意义(P均>0.05)。超声监测组与传统造影组相比,手术成功率差异无统计学意义(94.6%vs.100%,P>0.05),但射线剂量[(79.57±15.18)mGy vs.(219.22±34.60)mGy]、术中对比剂用量[0 ml vs.(62.22±22.69)ml]、血管并发症发生率(0%vs.13.9%)均明显较少(P均<0.05)。与术前相比,超声监测组术后24 h血肌酐[(51.86±12.75)μmol/L vs.(53.09±10.27)μmol/L]、尿素氮[(4.81±1.21)mmol/L vs.(4.98±0.93)mmol/L]水平无明显变化(P均>0.05);而传统造影组术后24 h血肌酐[(68.23±8.66)μmol/L vs.(59.23±22.12)μmol/L)]、尿素氮[(5.98±1.13)mmol/L vs.(5.16±1.49)mmol/L)]水平均升高(P均<0.05)。结论:超声心动图监测下无造影单侧股静脉入路PDA封堵术的成功率与传统主动脉造影介入封堵相似,并且少X线辐射、无对比剂损伤、血管并发症少,值得推广。Objectives:To explore the feasibility and clinical efficacy of interventional closure of patent ductus arteriosus(PDA)through single venous approach without angiography under ultrasound guidance.Methods:73 patients(21 males and 52 females)with PDA,who underwent PDA closure by different methods in Fuwai Hospital from January 2021 to May 2022,were enrolled in this retrospective study,including 37 cases with single venous approach without angiography under ultrasound guidance(ultrasound guidance group)and 36 cases with conventional arteriovenous approach(raditional angiography group).-The success rate of operation,complete closure rate at 24 hours,operation time,radiation dose,intraoperative contrast dose,preoperative and postoperative creatinine,preoperative and postoperative uric acid nitrogen and incidence of vascular complications were compared between the two groups.Results:There were no significant differences in age and sex between the two groups(both P>0.05).There were no significant differences in the success rate of operation(94.6%vs.100%,P>0.05)between the two groups.The radiation dose([79.57+15.18]mGy Vs.[219.22+34.60]mGy).intraoperative contrast dose(0 ml vs.[6222+22.69]m1),and the incidence of vascular complications(0%vs.13.9%)were significantly lower in the ultrasound guidance group than in the traditional angiography group(all P<0.05).There were no significant changes in creatinine([51.86±12.75]μmol/L vs.[53.09±10.27]μmol/L)and urea nitrogen([4.81±1.21]mmol/L vs.[4.98±0.93]mmol/L)before and after operation in ultrasound guidance group(both P>0.05).Creatinine level([68.23±8.66]μmol/L vs.[59.23±22.12]μmol/L)and urea nitrogen level([5.98±1.13]mmol/L vs.[5.16±1.49]mmol/L)at 24 h after operation were significantly increased in traditional angiography group(both P<0.05).Conclusions:Operation success rate of PDA closure via femoral venipuncture without angiography under ultrasound guidance is comparable with PDA closure via femoral arteriovenous puncture under traditional descending aortography.

关 键 词：介入治疗 动脉导管未闭 对比剂 超声心动图 

分 类 号：R541.4[医药卫生—心血管疾病]