经顺行静动脉环路介入治疗新生儿室间隔完整的危重型肺动脉瓣狭窄15例分析  

Analysis of 15 cases of critical pulmonary stenosis with intact ventricular septum in neonates treated by antegrade venous-arterial loop interventional therapy

作　　者：周国祥 纪志娴[1] 罗刚[1] 孙毅[1] 任悦义[1] 泮思林[1] Zhou Guoxiang;Ji Zhixian;Luo Gang;Sun Yi;Ren Yueyi;Pan Silin(Heart Center,Women and Children′s Hospital,Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,青岛266034

出　　处：《中华儿科杂志》2025年第2期163-167,共5页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(82471753,82271725);青岛市科技惠民示范引导专项(23-2-8-smjk-10-nsh);青岛大学“医学+”学科集群攻关项目(YX2024302)。

摘　　要：目的评价经顺行静动脉环路实施经皮球囊肺动脉瓣成形术(PBPV)治疗新生儿室间隔完整的危重型肺动脉瓣狭窄(CPS-IVS)的临床效果。方法回顾性病例总结。选择2020年9月至2023年9月于青岛大学附属妇女儿童医院经顺行静动脉环路PBPV治疗的CPS-IVS患儿15例为研究对象,分析患儿手术前后右心室功能参数、手术并发症以及随访结局。比较手术前后右心室收缩压变化、手术前后与随访期间经皮血氧饱和度(SpO_(2))和超声心动图的变化,组间比较采用配对样本t检验。结果15例CPS-IVS患儿男9例、女6例,手术时年龄(3.6±0.5)日龄,均于全身麻醉下成功实施顺行静动脉环路PBPV。术后即刻跨肺动脉瓣压差为(35±6)mmHg(1 mm Hg=0.133 kPa),右心室收缩压由(96±16)mmHg降至(59±14)mmHg(t=6.70,P<0.001),SpO_(2)(吸入氧浓度0.48)由术前0.86±0.07升至术后0.97±0.03(t=4.81,P<0.001);术后1个月所有患儿SpO_(2)(未吸氧)均已恢复正常,与术前相比差异有统计学意义(t=0.16,P<0.001)。术后即刻8例患儿出现轻中度舒张期肺动脉瓣反流,未出现重度肺动脉瓣反流;术前6例三尖瓣重度反流术后均减轻为轻中度。术后3个月,1例患儿因跨肺动脉瓣压差升高至74 mmHg,再次行PBPV,术后即刻跨肺动脉瓣压差降至27 mmHg,恢复良好。15例患儿术后规律随访,三尖瓣瓣环Z值明显改善,由术前-1.9±0.8升至末次随访时-0.4±0.1(t=6.88,P<0.001);末次随访残留肺动脉瓣轻中度反流3例,三尖瓣轻度反流2例,无中度及以上反流。结论经顺行静动脉环路干预治疗新生儿CPS-IVS安全有效。Objective To evaluate the clinical efficacy of percutaneous balloon pulmonary valvuloplasty(PBPV)via antegrade venous-arterial loop in neonates with critical pulmonary stenosis with intact ventricular septum(CPS-IVS).Methods A retrospective case review was conducted.Fifteen neonates with CPS-IVS who underwent PBPV via antegrade venous-arterial loop at the Women and Children′s Hospital,Qingdao University between September 2020 and September 2023 were included.Pre-and post-operative right ventricular functional parameters,surgical complications,and follow-up outcomes were analyzed.Paired-sample t-test was used to compare changes in right ventricular systolic pressure(RVSP),percutaneous oxygen saturation(SpO_(2)),and echocardiographic findings pre-and post-operatively,as well as during the follow-up period.Results Among the 15 neonates(9 males and 6 females)with CPS-IVS,the surgical age was(3.6±0.5)d.All neonates underwent successful PBPV via antegrade venous-arterial loop under general anesthesia.The immediate post-operative trans-pulmonary valve pressure gradient was(35±6)mmHg(1 mmHg=0.133 kPa),with a significant reduction in RVSP from(96±16)mmHg to(59±14)mmHg(t=6.70,P<0.001).SpO_(2)(with an inspired oxygen concentration of 0.48)increased from 0.86±0.07 pre-operatively to 0.97±0.03 post-operatively(t=4.81,P<0.001).One month postoperatively,SpO_(2)(without oxygen supplementation)normalized in all patients,with a statistically significant difference compared to pre-operative values(t=0.16,P<0.001).Immediately postoperative,mild to moderate diastolic pulmonary valve regurgitation was observed in 8 patients,with no cases of severe regurgitation.Additionally,the severity of tricuspid valve regurgitation decreased from severe to mild-to-moderate in 6 patients.Three months postoperatively,one patient underwent a second PBPV due to an increased trans-pulmonary valve pressure gradient of 74 mmHg,which decreased to 27 mmHg immediately after the procedure,with subsequent good recovery.Over a one-year follow-up period

关 键 词：婴儿 新生 肺动脉瓣狭窄 回顾性研究 

分 类 号：R722.1[医药卫生—儿科]