国产球囊导管二尖瓣扩张术中的严重并发症及原因分析  

Serious complications and reason analysis of percutaneous balloon mitral valvuloplasty with domestic catheter balloon

作　　者：张光征[1] 高文献[1] 阎培泉[1] 

机构地区：[1]临沂市沂水中心医院心内科,山东临沂276400

出　　处：《临床荟萃》2003年第16期917-919,共3页Clinical Focus

摘　　要：目的　总结分析国产球囊导管二尖瓣扩张术 (PBMV)严重并发症及导管异常情况的防治。方法　使用不同厂家生产的国产球囊 ,采用Inoue技术对 5 84例风湿性二尖瓣狭窄患者行PBMV治疗。结果　实施手术的 5 84例 ,成功率 98.6 % ,总严重并发症 2 6例 (4 .4 5 % ) ,死亡 2例 ,总病死率 (0 .3% )。其中室性心动过速、心室颤动 8例(1 .37% ) ,房水平分流 1 4例 (2 .4 % ) ;股静脉血肿 6例 (1 % ) ,导管折断 4例 (0 .7% ) ,球囊破裂 4例 (0 .7% ) ,体循环栓塞 3例 (0 .5 % ) ,急性心包填塞 3例 (0 .5 % ) ,重度二尖瓣返流 2例 (0 .3% ) ,急性左心衰 2例 (0 .3% )。结论　PBMV技术虽已成熟 ,但仍有一定风险。国产球囊导管质量较进口导管差 ,更容易出现严重并发症 ,而且导管也易出现异常情况。但只要严格选择适应证 ,术前认真做好导管测试 ,细致检查导管质量 ,规范操作程序 ,术中尽量减少大幅度操作 ,手法轻柔 。Objective To analyze the serious complications of percutaneous balloon mitral valvulopasty (PBMV) and the managements in the exceptional conditions of the catheter balloon.Methods Using domestic catheter balloons made in different manufactories,584 cases of patients with rheumatic mitral stenosis were treated with PBMV by Inoue way.Results Operative successful rate was 98.65% .Serious complications occurred in 26 patients ( 2.45% ),including 2 cases of death ( 0.34% ),8 tachycardia or ventricular fibrillation,14 intra atrial bypass ( 2.4% ),6 fermoral venous haematoma (1%),4 catheter fragmentation ( 0.7% ),4 balloon rupture ( 0.7% ),3 systemic thromboembolis,3 acute pericardial tamponade( 0.5% ),2 severe mitral regurgitation ( 0.3% ),2 acute left ventricular failure ( 0.3% ).Conclusion The results demonstrate that PBMV is an effective and reliable procedure in the treatment of rheumatic mitral stenois,but the quality of domestic catheter balloon is inferior to that of imports.A marked decrease in complication rates is attributable to refinement of patient selection,technical advance in procedure,mild operation and strict management of patients.

关 键 词：二尖辩狭窄 气囊扩张术 质量控制 

分 类 号：R054.25[医药卫生]