膜周部室间隔缺损老龄患者行介入封堵术疗效分析  

Analysis of curative effect of interventional closure in elderly patients with perimembranous ventricular septal defect

作　　者：孟立立 王建铭 朱鲜阳 庚靖淞 王琦光 MENG Li-li;WANG Jian-ming;ZHU Xian-yang;GENG Jing-song;WANG Qi-guang(Department of Congenital Heart Disease,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院先心病内科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第12期1216-1218,共3页Clinical Journal of Medical Officers

基　　金：辽宁省博士科研启动基金(2019-BS-266)。

摘　　要：目的探讨膜周部室间隔缺损(pmVSD)老龄患者行介入封堵术的临床效果。方法选取北部战区总医院自2009年1月至2019年12月收治的31例行介入封堵术的老龄患者为研究对象。应用国产改良双盘pmVSD封堵器或进口第二代Amplatzer动脉导管未闭封堵器进行pmVSD介入封堵术。分别于术后第1、3、6个月及每年进行随访,评价所有患者的封堵效果及并发症发生情况。采用多因素Logistic回归分析检验封堵术后高发心律失常的独立危险因素。结果31例患者中,即刻封堵成功率100.0%(31/31),完全封堵率为80.6%(25/31)。所有患者随访时间为(80.8±31.5)个月,中位随访时间为72个月。31例患者中,严重并发症发生率为6.5%(2/31),2例患者分别于术后第3、6年死亡,其余29例患者随访期间无感染性心内膜炎、封堵器栓塞、瓣膜反流等严重并发症。多因素Logistic回归分析显示,高龄、封堵器尺寸均为封堵术后高发心律失常的独立危险因素(P<0.05)。结论在严格筛选的pmVSD老龄患者中行介入封堵术安全有效,高龄与封堵器尺寸均为封堵术后高发心律失常的独立危险因素。Objective To investigate the clinical effect of interventional closure of perimembranous ventricular septal defect(pmVSD)in elderly patients.Methods A total of 31 elderly patients who underwent interventional occlusion from January 2009 to December 2019 were selected as the study objects.pmVSD interventional sealing was performed using domestic modified double disc pmVSD duct occluder or Amplatzer duct occluderⅡ.All patients were followed up at 1,3,6 months and annually to evaluate the blocking effect and complications.Multivariate Logistic regression analysis was used to examine the independent risk factors of high arrhythmia after plugging.Results In 31 patients,the success rate of immediate plugging was 100.0%(31/31),and the complete plugging rate was 80.6%(25/31).All patients were followed up for(80.8±31.5)months,with a median follow-up of 72 months.Among the 31 patients,the rate of serious complications was 6.5%(2/31),and 2 patients died at 3 and 6 years after surgery,respectively.The remaining 29 patients had no serious complications such as infective endocarditis,occluder embolism,and valvular reflux during follow-up.Multivariate Logistic regression analysis showed,old age and occlader size ratio were independent risk factors for high rate of arrhythmia after occluding(P<0.05).Conclusion Interventional plugging is safe and effective in aged pmVSD patients with strict screening.The ratio of age to occlusive size is an independent risk factor for high postoperative arrhythmia.

关 键 词：膜周部室间隔缺损 第二代Amplatzer动脉导管未闭封堵器 心间隔封堵装置 老龄 

分 类 号：R654.2[医药卫生—外科学]