经胸微创封堵对高危室间隔缺损患儿的疗效  

Efficacy of Trans-thoracic Minimally Invasive Closure in High-Risk Children with Ventricular Septal Defect

作　　者：王孝东[1] 杨再珍[1] 李玉杰[1] WANG Xiaodong;YANG Zaizhen;LI Yujie(Department of Cardiovascular Surgery,Zhengzhou People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院心血管外科,河南郑州450000

出　　处：《河南医学研究》2024年第14期2557-2561,共5页Henan Medical Research

摘　　要：目的探讨经胸微创封堵对高危室间隔缺损(VSD)患儿的疗效。方法选取2015年2月至2022年1月郑州人民医院收治的80例高危VSD患儿为研究对象,按照手术方法将其分为A、B两组,分别为36例、44例,A组患儿接受传统体外循环下VSD修补手术,B组患儿接受食管超声(TEE)引导下经胸微创封堵术治疗,两组患儿均随访1 a,记录并统计患儿总有效率、手术相关指标、心功能指标、炎症因子水平以及术后不良事件发生情况。结果B组临床总有效率(90.91%)较A组(72.22%)高(P<0.05);B组手术相关指标均优于A组(P<0.05);术后1 a,两组患儿左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)较术前均下降,左室射血分数(LVEF)较术前均升高(P<0.05);两组患儿术后1 a心功能指标对比,差异无统计学意义(P>0.05);相较于术前,两组患儿术后3 d血清C反应蛋白(CRP)及白细胞计数均下降(P<0.05),且术后3 d B组炎症因子水平低于A组(P<0.05);B组总的不良反应发生率(6.81%)较A组(22.22%)低(P<0.05)。结论应用TEE引导下经胸微创封堵术治疗高危VSD患儿,效果明确,可减轻术后炎症反应,促进心功能恢复,降低不良事件发生率。Objective To investigate the therapeutic effect of trans-thoracic minimally invasive closure on high-risk children with ventricular septal defect(VSD).Methods Eighty high-risk children with VSD who were admitted to Zhengzhou People’s Hospital from February 2015 to January 2022 were selected as the study subjects.Based on different surgical methods,the subjects were divided into group A(36 children treated with traditional VSD repair under extracorporeal circulation)and group B(44 children treated with TEE-guided trans-thoracic minimally invasive closure).All children were followed up for 1 year.The total effective rate,operation-related indicators,cardiac function indicators,inflammatory factor levels and the incidence of postoperative adverse events were recorded and analyzed.Results The total clinical response rate in group B(90.91%)was higher than that in group A(72.22%)(P<0.05).Operation-related indicators in group B were better than those in group A(P<0.05).One year after operation,left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)decreased,and left ventricular ejection fraction(LVEF)increased in the two groups(P<0.05).There was no significant difference in cardiac function indicators between the two groups(P>0.05).On the 3rd day after operation,C-reactive protein(CRP)levels and white blood cell count in the two groups decreased(P<0.05).The levels of inflammatory factors in group B were lower than those in group A(P<0.05).The total incidence rate of adverse events in group B(6.81%)was lower than that in group A(22.22%)(P<0.05).Conclusion TEE-guided trans-thoracic minimally invasive closure is effective in the treatment of high-risk children with VSD.It can alleviate postoperative inflammatory reactions,promote cardiac function recovery,and reduce the incidence of adverse events.

关 键 词：室间隔缺损 高危 食管超声 经胸微创封堵术 

分 类 号：R726[医药卫生—儿科]