CAJ | 학술논문

目的研究经导管介入治疗不同类型先天性心脏病（CHD）过程中引起心肌损伤的影响因素。方法介入治疗的患者200例,根据类型分室间隔缺损（VSD组，61例）、房间隔缺损（ASD组，69例）、动脉导管未闭（PDA组，55例）、肺动脉瓣狭窄（PS组，15例）；先天性心脏病造影的病例17例（造影组）。所有患者于术前及术后6h、24 h抽取静脉血检测心肌肌钙蛋白I（cTnI）含量，比较各组cTnI水平。根据cTnI的高低判断心肌损伤的严重程度，并采用单因素及logistic多因素回归分析各危险因素与心肌损害的关系。结果217例患儿中，术后cTnI升高159例，正常58例。单因素分析发现心肌损伤与年龄、体重、肺动脉压力、手术时间、封堵器大小、封堵器释放（或球囊扩张）次数及对比剂剂量有关（P＜0.01或0.05）。logistic回归分析发现手术时间、封堵器大小、封堵器释放次数、对比剂剂量、体重是心肌损伤的独立危险因素。结论手术时间、封堵器大小、封堵器释放次数、对比剂剂量、体重可能是影响CHD介入治疗心肌损伤程度的重要因素。
목적연구경도관개입치료불동류형선천성심장병（CHD）과정중인기심기손상적영향인소。방법개입치료적환자200례,근거류형분실간격결손（VSD조，61례）、방간격결손（ASD조，69례）、동맥도관미폐（PDA조，55례）、폐동맥판협착（PS조，15례）；선천성심장병조영적병례17례（조영조）。소유환자우술전급술후6h、24 h추취정맥혈검측심기기개단백I（cTnI）함량，비교각조cTnI수평。근거cTnI적고저판단심기손상적엄중정도，병채용단인소급logistic다인소회귀분석각위험인소여심기손해적관계。결과217례환인중，술후cTnI승고159례，정상58례。단인소분석발현심기손상여년령、체중、폐동맥압력、수술시간、봉도기대소、봉도기석방（혹구낭확장）차수급대비제제량유관（P＜0.01혹0.05）。logistic회귀분석발현수술시간、봉도기대소、봉도기석방차수、대비제제량、체중시심기손상적독립위험인소。결론수술시간、봉도기대소、봉도기석방차수、대비제제량、체중가능시영향CHD개입치료심기손상정도적중요인소。
Objective To explore the influence factors of myocardial damage in the process of transcatheter therapy of congenital heart disease. Methods Transcatheter intervention of 200 cases of congenital heart disease were performed, includ-ing 61 cases of Ventricular septal defect(Group VSD), 69 cases of Atrial septal defect(Group ASD), 55 cases of Patent ductus ar-teriosus(Group PDA) and 15 cases of Pulmonary stenosis(Group PS). There were 17 cases of congenital heart disease angiogra-phy(Group angiography). The level of cTnI was measured by CLIA method before and 6h, 24h after operation, and the risk fac-tors of myocardial damage were analysed with single factor analysis and Logistic regression. Results The level of cTnI in-creased after operation in 159 cases, while remained normal in another 58 cases. Single factor analysis indicated that the my-ocardial damage was correlated with age of patient, body weight, pulmonary artery pressure, operation time, the size of the oc-cluder, the occluder release time and dose of contrast medium (P<0.01 or 0.05). Logistic regression showed that body weight, operation time, the size of the occluder, the occluder release time and dose of contrast medium were independent risk factors of myocardial damage. Conclusion Body weight, operation time, the size of the occluder, the occluder release time and dose of contrast medium may be important influence factors of myocardial damage in the process of transcatheter therapy of congenital heart disease.