CAJ | 학술논문

目的随访观察儿童继发孔型房间隔缺损(ASD)介入治疗后并发症的发生及转归情况.方法 192例介入治疗成功且随访时间超过1个月的ASD患儿,ASD直径8.0～33.0 mm,平均(16.7±8.0)mm.128例应用Amplatzer房间隔封堵器,64例应用国产房间隔缺损封堵器,封堵器大小8.0～38.0 mm,平均(18.9±8.2)mm.随访时间1个月～4年,平均(19.0±4.5)个月.术前及术后24 h和术后1、3、6、12个月及以后每1～2年行超声心动图及心电图(ECG)检查.结果 ①并发症总的发生率为3.6%(7/192),其中残余分流占1.6%(3/192),窦性心动过缓占0.5%(1/192),Ⅰ度房室传导阻滞占0.5%(1/192),封堵器微移位并残余分流占0.5%(1/192),斑秃占0.5%(1/192).②ASD的大小和缺损的多少与并发症的发生情况:单孔型ASD共184例,并发症的发生率为2.7%(5/184),其中ASD≤10 mm 5例均无并发症发生,ASD10～20 mm者并发症的发生率为1.7%(2/119),ASD≥20 mm者并发症的发生率为5.0%(3/60);两孔和多孔型ASD共8例,并发症的发生率为25.0%(2/8).③并发症出现的时间:术后24 h内并发症的发生率为3.1%(6/192),分别为残余分流3例、Ⅰ度房宣传导阻滞1例、窦性心动过缓1例、封堵器微移位并残余分流1例;术后2 d～2周发生斑秃1例(0.5%,1/192).④并发症的处理情况:残余分流、封堵器微移位和斑秃患儿均未予特殊处理,窦性心动过缓者给予地塞米松和阿托品治疗,房室传导阻滞者给予地塞米松治疗.⑤并发症的转归情况:完全恢复4例(57.1%),分别为残余分流、Ⅰ度房宣传导阻滞、窦性心动过缓和斑秃各1例:少量残余分流2例和封堵器微移位1例未恢复.结论继发孔型房间隔缺损介入治疗后总的并发症少,大部分并发症在随访过程中可完全恢复,一些少见并发症仍需长期随访观察.
목적 수방관찰인동계발공형방간격결손(ASD)개입치료후병발증적발생급전귀정황.방법 192례개입치료성공차수방시간초과1개월적ASD환인,ASD직경8.0～33.0 mm,평균(16.7±8.0)mm.128례응용Amplatzer방간격봉도기,64례응용국산방간격결손봉도기,봉도기대소8.0～38.0 mm,평균(18.9±8.2)mm.수방시간1개월～4년,평균(19.0±4.5)개월.술전급술후24 h화술후1、3、6、12개월급이후매1～2년행초성심동도급심전도(ECG)검사.결과 ①병발증총적발생솔위3.6%(7/192),기중잔여분류점1.6%(3/192),두성심동과완점0.5%(1/192),Ⅰ도방실전도조체점0.5%(1/192),봉도기미이위병잔여분류점0.5%(1/192),반독점0.5%(1/192).②ASD적대소화결손적다소여병발증적발생정황:단공형ASD공184례,병발증적발생솔위2.7%(5/184),기중ASD≤10 mm 5례균무병발증발생,ASD10～20 mm자병발증적발생솔위1.7%(2/119),ASD≥20 mm자병발증적발생솔위5.0%(3/60);량공화다공형ASD공8례,병발증적발생솔위25.0%(2/8).③병발증출현적시간:술후24 h내병발증적발생솔위3.1%(6/192),분별위잔여분류3례、Ⅰ도방선전도조체1례、두성심동과완1례、봉도기미이위병잔여분류1례;술후2 d～2주발생반독1례(0.5%,1/192).④병발증적처리정황:잔여분류、봉도기미이위화반독환인균미여특수처리,두성심동과완자급여지새미송화아탁품치료,방실전도조체자급여지새미송치료.⑤병발증적전귀정황:완전회복4례(57.1%),분별위잔여분류、Ⅰ도방선전도조체、두성심동과완화반독각1례:소량잔여분류2례화봉도기미이위1례미회복.결론 계발공형방간격결손개입치료후총적병발증소,대부분병발증재수방과정중가완전회복,일사소견병발증잉수장기수방관찰.
Objective To observe the complications in children after percutaneeus closure of atrial septal defect (ASD). Methods 192 children,who successfully received percutaneous closure of ASD in our hospital were enrolled in this study. Diameter of ASD was 8.0 ～ 33.0( 16.7± 8.0) mm, the diameter of occluder was 8.0 ～ 38.0 ( 18.9 ± 8.2) mm. The follow-up term ranges from 1 month to 4 years, with a mean of 19.0 ± 4.5 months. Standard 12-lead electrocardiography (ECG) and transthoracic echocardiography (TIE) were performed before closure, 24 including: minimal-moderate residual shunt in 3 patients ( 1.6% ), atrial-ventricle block (AVB) in 1 ( 0.5 % ), sinus There were 184 cases of single-hole ASD, with complication rate of 2.7% (5/184) , including the complication rate in diameter of siagle-hole ASD less than 10mm was 0% , that in ASD between 10 mm and 20 mm was 1.7% (2/119) ,that in ASD more than 20 mm was 5.0% (3/60) ,while there were 8 cases of two- and multi-hole ASD, clusion, including 3 cases of minimal-moderate residual shunt, 1 case of atrial-ventricle block, 1 case of sinus brady-cardia, and 1 case of device-micro-malplesition. 2 days to 2 weeks after procedure, 1 case developed pelade ( 1/192 ). completely recovered (57. 1% ), including 1 case of residul shunt, 1 case of atrial-ventricle block, sinus bradycardia and 1 case of pelade. 2 cases of minimal residual and 1 case of device-micro-malposition were not recov-ered. Conclusions Transeatheter closure of ASD is safe and effective with few complications, most of which disapp-eare completely during follow up term. Long-term follow-up is needed to evaluate the progress of some rare complica-tions.