摘要
目的总结低体重长管型动脉导管未闭(patent ductus arteriosus,PDA)患儿使用非常规封堵器介入治疗的效果,为此类患儿选择有效介入治疗方法提供参考依据。方法收集2017年1月1日至2019年12月31日于湖南省儿童医院行介入封堵治疗的低体重长管型(直径≥3 mm)PDA患儿临床资料,根据选择的封堵器类型分为肌部室间隔缺损(ventricular septal defect,VSD)封堵器和二代Amplatzer PDA封堵器,总结两组患儿的病例特点和并发症发生率。结果本研究共纳入15例低体重长管型(直径≥3 mm)PDA患儿,年龄4.0(2.0~7.5)个月,平均体重(4.85±1.15)kg;采用肌部VSD封堵器9例,平均体重(5.32±1.17)kg,PDA长度和直径分别为(9.71±1.50)mm和(5.03±1.00)mm。术前平均心胸比为(0.65±0.03),术后心胸比为(0.61±0.03),差异有统计学意义(t=2.3,P=0.04)。3例发生残余瘘,2例出现降主动脉狭窄,5例血小板降低。采用二代Amplatzer PDA封堵器6例,平均体重(4.15±0.75)kg,PDA长度和直径分别为(8.0±0.50)mm和(3.67±0.82)mm;术前平均心胸比为(0.61±0.03),术后平均心胸比为(0.58±0.03),差异有统计学意义(t=2.1,P=0.04)。4例发生残余瘘,1例出现降主动脉狭窄。无一例发生左肺动脉狭窄或封堵器移位、脱落等情况。结论低体重粗长管型动脉导管未闭通过肌部VSD封堵及二代Amplatzer PDA封堵器,均能获得良好的治疗效果,且能最大限度保护血管;肌部VSD封堵器更适用于动脉导管直径≥5 mm以上患儿,但术后血小板降低发生率较高;二代Amplatzer PDA封堵器适用于动脉导管直径3~5 mm的患儿,需警惕残余瘘及左肺动脉狭窄的发生。
Objective To summarize the therapeutic strategy and effectiveness of unconventional device application in low-weight children with long patent ductus arteriosus(PDA).Methods Methods From January 2017 to December 2019,clinical data of low-weight children with long PDA(diameter>3 mm)were retrospectively analyzed.They were divided into two groups of muscular ventricular septal defect(MVSD)and second-generation Amplatzer PDA.Clinical manifestations and incidence of complications were summarized.Results There were a total of 15 patients with an average age of 4(2.0-7.5)months and an average body weight of(4.85±1.15)kg.PDA closure was successfully achieved by MVSD occluder(n=9)or second-generation Amplatzer PDA occluder(n=6).Body weight was(5.32±1.17)kg in MVSD occluder group and(4.15±0.75)kg in second-generation Amplatzer PDA group respectively.And the length and diameter of PDA were(9.71±1.50)and(5.03±1.00)mm in MVSD occluder group and(8.0±0.5)and(3.67±0.82)mm in second-generation Amplatzer PDA group respectively.There were 3 cases of comorbidity with residual shunt in MVSD occluder group and comorbidities with descending aortic stenosis(n=2)and thrombocytopenia(n=5)in MVSD occluder group.Cardiothoracic ratio declined markedly(P<0.05)post-operation compared with pre-operation in MVSD occluder group(0.61±0.03 vs.0.65±0.03)and second-generation Amplatzer PDA occluder group(0.58±0.03 vs.0.61±0.03).Comorbidity with residual shunt(n=4)and descending aortic stenosis(n=1)occurred in second-generation Amplatzer PDA occluder group.Dislocation and shift of device or stenosis of left pulmonary was not detected.Conclusion Low-weight children with long PDA(diameter>3 mm)may be effectively treated by MVSD occluder and second-generation Amplatzer PDA occluder.The former is suitable for PDA with a diameter of>5 mm while the latter is ideal for PDA with a diameter of between 3-5mm.
作者
左超
陈智
肖云彬
杨美玉
王野峰
王祥
王丹
Zuo Chao;Chen Zhi;Xiao Yunbin;Yang Meiyu;Wang Yefeng;Wang Xiang;Wang Dan(Hunan Children's Hospital,Changsha 410007,China)
出处
《临床小儿外科杂志》
CAS
2020年第10期930-934,共5页
Journal of Clinical Pediatric Surgery
基金
湖南省卫生计生委科研计划课题项目(编号:B2019014)。
关键词
婴儿
出生时低体重
动脉导管未闭
治疗结果
Infant,Low Birth Weight
Ductus Arteriosus,Patent
Treatment Outcome
