| 摘要: |
| 目的 评价甘肃省高原、亚高原地区婴幼儿动脉导管未闭（PDA）封堵治疗的安全性及有效性。方法 选择2008年1月至2018年1月于甘肃省人民医院行封堵治疗的PDA患儿300例，年龄为6个月至3岁，其中高原地区123例、亚高原地区177例。术中封堵前经右心导管测量肺动脉压，根据PDA的形态选择适宜的封堵器，对有轻度肺动脉高压的患儿行封堵治疗，对有中-重度肺动脉高压患儿则行试封堵治疗。术后1、3、6个月随访时行超声心动图检查，并根据右房室瓣反流速度评估肺动脉压的变化。结果 300例PDA患儿封堵前即刻血管造影显示缺损，缺损直径为1～10（4.5±2.8）mm。封堵后293例患儿无残余分流。299例患儿封堵手术成功，其中97例伴中-重度肺动脉高压的患儿均行吸高氧试验，对吸高氧后血氧饱和度<95%的21例患儿行试封堵治疗。235例患儿采用PDA封堵器进行封堵，53例微小动脉导管采用德国PFM医疗集团生产的Duct-Occlud弹簧圈，11例患儿采用膜部室间隔缺损封堵器。1例3岁患儿封堵后即刻肺动脉收缩压增高，其家属放弃进一步治疗。术后6个月299例患儿的肺动脉收缩压、平均肺动脉压均有不同程度的降低。结论 封堵治疗甘肃省高原、亚高原地区婴幼儿PDA成功率高；试封堵治疗是一种鉴定严重肺动脉高压性质非常可靠的方法；术中根据个体情况选择合适的封堵器械能取得良好的临床效果。 |
| 关键词: 动脉导管未闭 婴儿 儿童 高原及亚高原地区 甘肃省 封堵器 肺动脉高压 |
| DOI：10.16781/j.0258-879x.2019.09.1036 |
| 投稿时间：2019-05-08修订日期：2019-06-26 |
| 基金项目:甘肃省科技计划项目（18YF1WA040）. |
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| Efficacy and safety of occlusion therapy for patent ductus arteriosus infants in plateau and sub-plateau of Gansu Province, China |
| WANG Jian-jun*,FAN Wen-hai,SUN Yong-hong,CUI Wei-jing,LEI Xiao-yan |
(Department of Pediatrics, Gansu Provincial People's Hospital, Lanzhou 730000, Gansu, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the safety and efficacy of occlusion therapy for patent ductus arteriosus (PDA) infants in Gansu plateau and sub-plateau of China. Methods A total of 300 PDA infants treated in Gansu Provincial People's Hospital between Jan. 2008 and Jan. 2018, including 123 patients from plateau area and 177 patients from sub-plateau area, were enrolled in this study. Their ages ranged from 6 months to 3 years. Anterior right heart catheter was blocked for measuring pulmonary artery pressure before occlusion during surgery. Different occlusion devices were selected according to the characteristics of PDA during the operation. Occlusion treatment for PDA patients with mild pulmonary hypertension was processed and testing occlusion was given to patients with moderate to severe pulmonary hypertension. After 1, 3, and 6 months follow-up, electrocardiogram, echocardiography and other data were examined, and changes in pulmonary artery pressure were evaluated based on the rate of tricuspid regurgitation. Results A total of 300 patients receiving angiography showed defects, with the defect diameter being 1-10 (4.5±2.8) mm before operation. After occlusion, 293 infants had no residual shunt. Totally 299 patients were successfully operated, and 97 patients with moderate to severe pulmonary hypertension were tested for hyperoxia and 21 infants with oxygen saturation <95% were given testing occlusion operation. And 235 patients were successfully blocked with PDA occlude, 53 micro-arterial catheters were occluded with German PFM Duct-Occlud, and 11 treated with ventricular septal defect occlude. One case aged 3 years old gave up treatment due to elevation of pulmonary artery pressure immediately after occlusion. Pulmonary systolic pressure and mean pulmonary artery pressure decreased in 299 patients 6 months after operation. Conclusion Occlusion therapy is a reliable method for PDA infants in plateau and sub-plateau areas of Gansu Province, China, with definite curative effect and high success rate. Testing occlusion is a reliable method for identifying severe pulmonary hypertension, and choosing an appropriate occlusion device according to the individual conditions can achieve promising clinical outcomes. |
| Key words: patent ductus arteriosus infant child plateau and sub-plateau areas Gansu Province occluder pulmonary hypertension |
