CAJ | 학술논문

目的探讨经胸超声心动图(TTE)引导下行房间隔缺损封堵术的可行性.方法入选2013年2至8月在阜外心血管病医院行超声心动图引导下封堵术的单纯房间隔缺损患者65例进行回顾性分析.根据引导方式的不同,将患者分为TTE组(30例)和经食管超声心动图(TEE)组(35例).TTE组患者在局部麻醉或基础麻醉下,仅在TTE引导下行房间隔缺损封堵术;TEE组患者在全身麻醉和气管插管下,仅在TEE引导下行房间隔缺损封堵术.术后1个月在门诊随访,复查超声心动图和心电图.结果 TTE组的28例患者成功置入封堵器;其余2例患者因TTE图像显示不清,改为在TEE引导下行房间隔缺损封堵术.两组患者的年龄、体质量、房间隔缺损直径、住院时间差异均无统计学意义(P均＞0.05).与TEE组比较,TTE组的手术时间较短[(52.77±9.00) min比(60.11±9.15)min,P＜0.05],呼吸机通气时间较短[(0.25 ±0.95)h比(3.17±0.69)h,P＜0.05],重症监护室住院时间较短[(1.50±1.96)h比(16.43±6.99)h,P＜0.05],丙泊酚使用量较少[(2.41±2.97) mg/kg比(9.43±3.70)mg/kg,P＜0.05].两组患者在住院期间均无残余分流、外周血管损伤和心脏穿孔等并发症.术后1个月随访,两组患者均无封堵器脱落、残余分流和心包积液等并发症.结论在TTE引导下行房间隔缺损封堵术是可行的,具有广泛的应用前景.
목적 탐토경흉초성심동도(TTE)인도하행방간격결손봉도술적가행성.방법 입선2013년2지8월재부외심혈관병의원행초성심동도인도하봉도술적단순방간격결손환자65례진행회고성분석.근거인도방식적불동,장환자분위TTE조(30례)화경식관초성심동도(TEE)조(35례).TTE조환자재국부마취혹기출마취하,부재TTE인도하행방간격결손봉도술;TEE조환자재전신마취화기관삽관하,부재TEE인도하행방간격결손봉도술.술후1개월재문진수방,복사초성심동도화심전도.결과 TTE조적28례환자성공치입봉도기;기여2례환자인TTE도상현시불청,개위재TEE인도하행방간격결손봉도술.량조환자적년령、체질량、방간격결손직경、주원시간차이균무통계학의의(P균＞0.05).여TEE조비교,TTE조적수술시간교단[(52.77±9.00) min비(60.11±9.15)min,P＜0.05],호흡궤통기시간교단[(0.25 ±0.95)h비(3.17±0.69)h,P＜0.05],중증감호실주원시간교단[(1.50±1.96)h비(16.43±6.99)h,P＜0.05],병박분사용량교소[(2.41±2.97) mg/kg비(9.43±3.70)mg/kg,P＜0.05].량조환자재주원기간균무잔여분류、외주혈관손상화심장천공등병발증.술후1개월수방,량조환자균무봉도기탈락、잔여분류화심포적액등병발증.결론 재TTE인도하행방간격결손봉도술시가행적,구유엄범적응용전경.
Objective To explore the feasibility of transcatheter closure of atrial septal defect (ASD) under transthoracic echocardiography (TTE) guidance.Methods Retrospective analysis was performed in 65 patients with simple ASD who underwent transcatheter closure under echocardiography guidance in Fuwai hospital from February to August 2013.They were divided into TTE group (n =30) and transesophageal echocardiography (TEE) group (n =35).The TTE group patients who underwent localized anesthesia or basal anesthesia received transcatheter closure of ASD under the guidance of TTE.The TEE group patients who underwent tracheal intubation and general anesthesia received transcatheter closure of ASD under the guidance of TEE.The patients were followed up with TTE and electrocardiogram at one month after procedure at outpatient department.Results In the TTE group,28 occluders were implanted successfully and 2 patients were subsequently switched to TEE guidance because of unclear TTE images,and the occluder implantation in these 2 patients was successful.There were no obvious differences in age,sex,body weight,ASD size,and time of hospital stay between the two groups (all P ＞ 0.05).Compared with TEE group,the TTE group had a significantly shorter operation time ((52.77 ± 9.00) min vs.(60.11 ±9.15)min,P＜0.05),respirator ventilation duration ((0.25 ±0.95)h vs.(3.17 ±0.69)h,P ＜0.05),and stay time in ICU ((1.50 ± 1.96) h vs.(16.43 ± 6.99) h,P ＜ 0.05).The dose of propofol required was significantly lower in the TTE group compared to TEE group ((2.41 ± 2.97)mg/kg vs.(9.43 ±3.70)mg/kg,P ＜ 0.05).The patients in both groups had no complications such as residual shunt,peripheral vascular injury or cardiac perforation at the time of hospitalization.No complications,such as occluder dislocation,residual shunt,or pericardial effusion were seen during follow-up at one month post procedure in both groups.Conclusion Transcatheter closure of ASD under TTE guidance is feasible and has a broad application prospects.