中国循环杂志
中國循環雜誌
중국순배잡지
Chinese Circulation Journal
2015年
10期
967-970
,共4页
欧阳文斌%胡盛寿%王珊%逄坤静%王首正%刘垚%张大伟%张凤文%郭改丽%李守军%潘湘斌
歐暘文斌%鬍盛壽%王珊%逄坤靜%王首正%劉垚%張大偉%張鳳文%郭改麗%李守軍%潘湘斌
구양문빈%호성수%왕산%방곤정%왕수정%류요%장대위%장봉문%곽개려%리수군%반상빈
动脉导管未闭%微创手术%封堵%婴幼儿
動脈導管未閉%微創手術%封堵%嬰幼兒
동맥도관미폐%미창수술%봉도%영유인
Patent ductus arteriosus%Minimally invasive operation%Occlusion%Infants and young children
目的：探讨经胸微创封堵术治疗婴幼儿动脉导管未闭（PDA）的安全性及有效性。<br> 方法：收集2012-10至2014-10期间在我院接受经胸微创封堵术的105例婴幼儿PDA患者临床资料，进行回顾性分析。根据动脉导管内径大小，将患儿分为大口径组（动脉导管内径≥4 mm，n=64）和中小口径组（2 mm≤动脉导管内径<4 mm，n=41）。两组患儿术中均在胸骨上窝超声引导下经左侧胸骨旁第三肋间进行动脉导管封堵，以经胸超声心动图评价术后效果。术后1个月、3个月、6个月及每年进行超声心动图随访。<br> 结果：105例患儿均成功置入封堵器。两组患儿性别、年龄、体质量、气管插管时间及住院时间差异均无统计学意义（P均>0.05）。大口径组与中小口径组相比，患儿PDA直径[（5.7±1.4）mm vs（2.7±0.6）mm，P<0.001]及封堵器直径[（10.6±1.8）mm vs（7.2±1.3）mm，P<0.001]较大；术后中、重度血小板减少发生率[10.9%（7/64）vs 0（0/41）， P=0.028]及术后即刻残余分流率[15.6%（10/64）vs 2.4%（1/41），P=0.031]较高。大口径组1例患儿术后2天因出血致心包压塞，急诊行心包引流术后痊愈。术后随访（11.6±7.8）个月，两组患儿术后1个月残余分流发生率无明显差异[1.6%（1/64）vs 0（0/41），P=0.421]，术后3个月两组患儿均无残余分流。两组患儿在随访期间均无封堵器脱落、溶血、心包积液及左肺动脉和降主动脉狭窄等并发症。<br> 结论：经胸微创封堵术治疗婴幼儿PDA是一种安全、有效的方法。但对于大口径PDA患儿，需注意术后残余分流及血小板减少的观察和随访。
目的：探討經胸微創封堵術治療嬰幼兒動脈導管未閉（PDA）的安全性及有效性。<br> 方法：收集2012-10至2014-10期間在我院接受經胸微創封堵術的105例嬰幼兒PDA患者臨床資料，進行迴顧性分析。根據動脈導管內徑大小，將患兒分為大口徑組（動脈導管內徑≥4 mm，n=64）和中小口徑組（2 mm≤動脈導管內徑<4 mm，n=41）。兩組患兒術中均在胸骨上窩超聲引導下經左側胸骨徬第三肋間進行動脈導管封堵，以經胸超聲心動圖評價術後效果。術後1箇月、3箇月、6箇月及每年進行超聲心動圖隨訪。<br> 結果：105例患兒均成功置入封堵器。兩組患兒性彆、年齡、體質量、氣管插管時間及住院時間差異均無統計學意義（P均>0.05）。大口徑組與中小口徑組相比，患兒PDA直徑[（5.7±1.4）mm vs（2.7±0.6）mm，P<0.001]及封堵器直徑[（10.6±1.8）mm vs（7.2±1.3）mm，P<0.001]較大；術後中、重度血小闆減少髮生率[10.9%（7/64）vs 0（0/41）， P=0.028]及術後即刻殘餘分流率[15.6%（10/64）vs 2.4%（1/41），P=0.031]較高。大口徑組1例患兒術後2天因齣血緻心包壓塞，急診行心包引流術後痊愈。術後隨訪（11.6±7.8）箇月，兩組患兒術後1箇月殘餘分流髮生率無明顯差異[1.6%（1/64）vs 0（0/41），P=0.421]，術後3箇月兩組患兒均無殘餘分流。兩組患兒在隨訪期間均無封堵器脫落、溶血、心包積液及左肺動脈和降主動脈狹窄等併髮癥。<br> 結論：經胸微創封堵術治療嬰幼兒PDA是一種安全、有效的方法。但對于大口徑PDA患兒，需註意術後殘餘分流及血小闆減少的觀察和隨訪。
목적：탐토경흉미창봉도술치료영유인동맥도관미폐（PDA）적안전성급유효성。<br> 방법：수집2012-10지2014-10기간재아원접수경흉미창봉도술적105례영유인PDA환자림상자료，진행회고성분석。근거동맥도관내경대소，장환인분위대구경조（동맥도관내경≥4 mm，n=64）화중소구경조（2 mm≤동맥도관내경<4 mm，n=41）。량조환인술중균재흉골상와초성인도하경좌측흉골방제삼륵간진행동맥도관봉도，이경흉초성심동도평개술후효과。술후1개월、3개월、6개월급매년진행초성심동도수방。<br> 결과：105례환인균성공치입봉도기。량조환인성별、년령、체질량、기관삽관시간급주원시간차이균무통계학의의（P균>0.05）。대구경조여중소구경조상비，환인PDA직경[（5.7±1.4）mm vs（2.7±0.6）mm，P<0.001]급봉도기직경[（10.6±1.8）mm vs（7.2±1.3）mm，P<0.001]교대；술후중、중도혈소판감소발생솔[10.9%（7/64）vs 0（0/41）， P=0.028]급술후즉각잔여분류솔[15.6%（10/64）vs 2.4%（1/41），P=0.031]교고。대구경조1례환인술후2천인출혈치심포압새，급진행심포인류술후전유。술후수방（11.6±7.8）개월，량조환인술후1개월잔여분류발생솔무명현차이[1.6%（1/64）vs 0（0/41），P=0.421]，술후3개월량조환인균무잔여분류。량조환인재수방기간균무봉도기탈락、용혈、심포적액급좌폐동맥화강주동맥협착등병발증。<br> 결론：경흉미창봉도술치료영유인PDA시일충안전、유효적방법。단대우대구경PDA환인，수주의술후잔여분류급혈소판감소적관찰화수방。
Objective: To investigate the safety and efficacy of transthoracic minimally invasive patent ductus arteriosus (PDA) occlusion in infants and young children. <br> Methods: We retrospectively analyzed 105 infants and young children who received the transthoracic minimally invasive PDA occlusion in our hospital from 2012-10 to 2014-10. According to PDA diameter, patients were divided into 2 groups:Group A, the patients with PDA diameter ≥ 4 mm,n=64 and group B, the patients with 2 mm ≤ PDA diameter < 4 mm,n=41. All patients received the left third parasternal intercostal incision under suprasternal echocardiography guidance. The operative effect was evaluated by transthoracic echocardiography, and the follow-up study was performed at 1 month, 3 months, 6 months period and then annually after the operation by echocardiography. <br> Results: All 105 patients had successfully implanted PDA occluders. The patients’ gender, age, body weight, tracheal intubation time and the in-hospital time were similar between 2 groups,P>0.05. Compared with Group B, Group A had the larger diameters of PDA (5.7 ± 1.4) mm vs (2.7 ± 0.6) mm, P<0.001, PDA occluders (10.6 ± 1.8) mm vs (7.2 ± 1.3) mm, P<0.001, and the higher rates of moderate and severe post-operative thrombocytopenia 10.9% (7/64) vs 0% (0/41),P=0.028, immediate post-operative residual shunt as 15.6% (10/64) vs 2.4% (1/41),P=0.031. There was 1 patient in Group A suffered from pericardial tamponade due to hemorrhage at 2 days after operation and he was cured by emergent pericardial drainage. The patients were followed-up for (11.6 ± 7.8) months. The 1 month post-operative residual shunt was similar between 2 groups as 1.6% (1/64 ) vs 0% (0/41),P=0.421, and there was no residual shunt at 3 months after the operation. There were no complications of occluder detachment, hemolysis, pericardial effusion, left pulmonary artery or descending aortic stenosis occurred during the follow-up period. <br> Conclusion: Transthoracic minimally invasive PDA occlusion is a safe and effective method to treat the relevant infants and young children, while the post-operative residual shunt and thrombocytopenia should be closely observed in patients with large PDA.
