摘要
目的:评估蘑菇伞形导管封堵器经皮封堵婴儿及儿童动脉导管未闭的安全性和有效性,特别是选择封堵器尺寸的标准。方法:动脉导管未闭患儿96例,年龄4个月～12岁,中位年龄22个月,体质量5.5～37.5kg,中位体质量11kg。因心功能衰竭(心衰)、肺炎入院者58例,因生长迟缓、肺炎或反复呼吸道感染27例,仅因杂音入院者11例。动脉导管最窄处直径(3.4±1.9)mm,Qp/Qs为2.5±1.1,Rp/Rs为0.21±0.12。随访77例,随访时间为1～42个月。结果:封堵成功率94.8%。使用封堵器直径/动脉导管直径≥1.50的最小封堵器占73.6%。即刻、2d、1个月及3个月累积完全封堵率分别为64.8%、86.8%、97.8%和100%。1例出现轻度主动脉狭窄,仍在随访中。无左肺动脉狭窄患儿。5例出现暂时性Ⅰ度或Ⅱ度Ⅰ型房室传导阻滞,2例出现暂时性Q-T延长。1例术后输血50mL。无封堵器脱落、移位、溶血、感染、周围血管破裂及血栓形成。封堵后心衰及肺炎迅速消失。结论:本法对大多数婴儿及儿童动脉导管未闭安全、有效。封堵器直径/动脉导管直径≥1.5的最小封堵器可以首选使用。当主动脉峡部直径小于6mm或与动脉导管直径接近时,应十分谨慎。
Objective： To assess the value of percutaneous closure of patent duct arteriosus （PDA） using mushroomshaped duct occluder in infants and children, in particular size of the duct occluder. Methods： From October 2002 to November 2007, ninety-six cases underwent percutaneous closure. The median age was 22 months （range 4 months to 12 years）. The median weight was 11 kg（range 5.5 kg to 37.5 kg）. Fifty-eight cases had heart failure or pneumonia, 27 cases had growth delay or repeated respiratory infection, and 11 cases were admitted only for murmur. The diameter of PDA was （3.4±1.9）mm, Qv/Qs was 2.5±1.1, Rp/Rs was 0.21±0.12. Seventy-seven cases were followed-up for one month to 42 months. Results： Successful closure rate was 94.8%, complete closure rate were 64.8% （immediate）, 85.4% （2 days）, 97.8%（1 month） and 100%（3 month）. After operating, slight descending aorta stenosis took place in one case, which is still under observation. Temporary I degree or mobitz A-V block occurred in 5 cases and temporary Q-T prolongation was found in 2 cases. One case had 50 mL blood trans- fusing after the operation. No device embolism, dislocation, haemolysis, infection, vascular rupture and thrombosis were found. Heart failure and pneumonia disappeared in a few days in successful closure cases. Conclusion： Pereutaneous closure of PDA using mushroom-shaped occluder was safe and effective in majority of infants and children. The first choice of occluder was the minimum size, when diameter of oceluder/diameter of PDA was more than 1.50. If the diameter of aortic isthmus is less than 6 mm - 7 mm or it is close to the diameter of PDA, the operation should be taken carefully.
出处
《天津医药》
CAS
北大核心
2009年第1期28-30,共3页
Tianjin Medical Journal
关键词
动脉导管未闭
婴儿
儿童
封堵器
duetus arteriosus, patent infant child occluder
