第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的疗效分析
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摘要
目的初步分析第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的疗效,为更加系统地治疗小儿先天性心脏病提供理论依据。方法选取四川省医学科学院四川省人民医院儿科2016年11月至2017年11月收治且符合纳入标准的46例先天性心脏病患儿作为研究对象,采用随机分组的方法将患儿分成第一代Cera动脉导管未闭封堵器(ADOⅠ)组和第二代Cera动脉导管未闭封堵器(ADOⅡ)组,所有患儿选用Cera动脉导管未闭封堵器(均符合治疗准则及患儿的解剖特点),每组各23例;并比较围术期两组患儿的气管导管拔除时间、ICU滞留时间,超声心动图监测结果以及出院时、出院后1个月和出院后3个月的红细胞、红细胞压积、血红蛋白指标计数等指标。结果 ADOⅡ组患儿气管导管拔除时间、ICU滞留时间显著低于ADOⅠ组(P <0. 05)。两组患儿治疗前后超声心动图监测结果显示,ADOⅡ组出院后1个月和出院后3个月射血分数、左室短轴缩短百分率、每搏输出量均显著高于ADOⅠ组(P <0. 05),而舒张末期左心房内径显著低于ADOⅠ组(P <0. 05)。两组患儿出院时、出院后1个月和出院后3个月比较,红细胞、红细胞压积、血红蛋白指标计数的差异均有统计学意义(P <0. 05)。从治疗结局来看,ADOⅠ组有效率为82. 61%、ADOⅡ组有效率为95. 65%,差异有统计学意义(P <0. 05)。结论第二代Cera动脉导管未闭封堵器介入治疗小儿先天性心脏病的整体疗效更佳,值得临床推广。
Objective To explore the efficacy of second-generation Cera patent ductus arteriosus(PDA occluder in the interventional treatment of congenital heart disease(CHD) in children and provide a theoretical basis for managing CHD in children.Methods Forty-six hospitalized CHD children from November 2016 to November 2017 were selected and randomly divided into ADOⅠand ADOⅡgroups(n = 23 each).Duration of intensive care unit(ICU) stay,imaging of echocardiography and statistic differences of erythrocyte,hematocrit and hemoglobin counts at discharge and 1/3 months post-discharge were compared.Results Tracheal catheter removal time and ICU stay duration were significantly shorter in ADOⅡgroup than those in ADOⅠgroup(P <0.05).As demonstrated by echocardiographic monitoring results before and after treatment,ejection fraction,left ventricular fractional shortening and stroke output were significantly higher at 1/3 months post-discharge in ADOⅡgroup than those in ADOⅠgroup.And end-diastolic left atrium diameter was significantly lower than that of ADOⅠgroup.At discharge and 1/3 months post-discharge,two groups had statistically significant differences in erythrocyte,hematocrit and hemoglobin count(P < 0.05).As for treatment outcomes,ADOⅠand II groups had an effective rate of 82.61% and 95.65% respectively and the difference was statistically significant(P <0.05).Conclusion The second-generation Cera PDA occluder offers better intervention of CHD children than its first-generation cousin.Wider clinical popularization is warranted.
Objective To explore the efficacy of second-generation Cera patent ductus arteriosus(PDA occluder in the interventional treatment of congenital heart disease(CHD) in children and provide a theoretical basis for managing CHD in children.Methods Forty-six hospitalized CHD children from November 2016 to November 2017 were selected and randomly divided into ADOⅠand ADOⅡgroups(n = 23 each).Duration of intensive care unit(ICU) stay,imaging of echocardiography and statistic differences of erythrocyte,hematocrit and hemoglobin counts at discharge and 1/3 months post-discharge were compared.Results Tracheal catheter removal time and ICU stay duration were significantly shorter in ADOⅡgroup than those in ADOⅠgroup(P <0.05).As demonstrated by echocardiographic monitoring results before and after treatment,ejection fraction,left ventricular fractional shortening and stroke output were significantly higher at 1/3 months post-discharge in ADOⅡgroup than those in ADOⅠgroup.And end-diastolic left atrium diameter was significantly lower than that of ADOⅠgroup.At discharge and 1/3 months post-discharge,two groups had statistically significant differences in erythrocyte,hematocrit and hemoglobin count(P < 0.05).As for treatment outcomes,ADOⅠand II groups had an effective rate of 82.61% and 95.65% respectively and the difference was statistically significant(P <0.05).Conclusion The second-generation Cera PDA occluder offers better intervention of CHD children than its first-generation cousin.Wider clinical popularization is warranted.
引文
1张长海,刘晓桥,张萍,等.轨道法在特殊动脉导管未闭介入治疗中的应用[J].贵州医科大学学报,2017,42(10):1168-1171.Zhang CH,Liu XQ,Zhang P,et al.Application of railing method in the treatment of unclosed interventional therapy for special arterial catheters[J].Journal of Guizhou Medical U-niversity,2014,42(10):1168-1171.
2鞠樑,钱炜,李红,等.国产封堵器经导管介入封堵104例儿童先天性心脏病的临床分析[J].中华全科医学,2017,15(10):1735-1737+1801.JU L,Qian W,Li H,et al.Clinical analysis of congenital heart disease in children by catheter intervention:a report of104 cases[J].Chinese general medicine,2015,15(10):1735-1737+1801.
3王祥,陈智,肖云彬,等.第二代Amplatzer动脉导管未闭封堵器介入治疗小儿先天性心脏病[J].中国介入心脏病学杂志,2017,25(9):498-501.Wang Q,Chen Z,Xiao YB,et al.Role of second-generation Amplatzer arterial catheter in the treatment of congenital heart disease in children[J].China Journal of Interventional Cardiology,2017,25(9):498-501.
4周建华,单文军,黄建波,热娜.国产血管塞介入治疗儿童特殊类型动脉导管未闭疗效观察[J].海南医学,2017,28(15):2524-2525.Zhou JH,Shan WJ,Huang JB.Domestic angiocardial interventional therapy for children with special type of arterial catheter[J].Hainan Medicine,2011,28(15):2524-2525.
5 Do Carmo JM,da Silva AA,Wang Z,et al.Regulation of blood pressure,appetite and glucose by leptin after inactivation of insulin receptor substrate 2 signaling in the entire brain or in proopiomelanocortin neurons[J].Hypertension,2016,67(2):378-386.
6官文俊,许臣洪.动脉导管未闭封堵术后血小板减少临床分析[J].现代仪器与医疗,2017,23(3):14-15+20.Guan WJ,Xu CH.Clinical analysis of postoperative thrombrocytopenia after occluding patent ductus arteriosus[J].Modern Instruments&Medical Treatment,2013,23(3):14-15+20.
7 Cowie B,Kluger R,Rex S,et al.The relationship between pulmonary artery acceleration time and mean pulmonary artery pressure in patients undergoing cardiac surgery:An observational study[J].Eur J Anaesthesiol,2016,33(1):28-33.
8于波,孔祥清,张智伟,等.中国动脉导管未闭介入治疗指南2017[J].中国介入心脏病学杂志,2017,25(5):241-248.Yu B,Kong XQ,Zhang ZW,et al.Therapeutic Guidelines of Patent Ductus Arteriosus in China(2017 Edition)[J].Chinese Journal of Interventional Cardiology,2017,25(5):241-248.
9程真莉,李谧,吕铁伟,等.小儿动脉导管未闭介入封堵术后严重血小板减少临床分析[J].第三军医大学学报,2017,39(14):1486-1492.Chen ZL,Li M,Lv TW,et al.Clinical analysis of severe thrombocytopenia after interventional closure of pediatric arterial catheter[J].Journal of Third Military Medical University,2013,39(14):1486-1492.
10肖家旺,朱鲜阳,王琦光,等.经导管封堵主动脉窦瘤破入右心房的临床疗效及长期随访结果[J].中国介入心脏病学杂志,2017,25(3):127-132.Xiao JW,Zhua XY,Wang QG,et al.Clinical efficacy and long-term follow-up outcomes of catheter closing of aortic sinus tumor in right atrium[J].China Journal of Interventional Cardiology,2013,25(3):127-132.
11 Borgo MV,Claudio ER,Silva FB,et al.Hormonal therapy with estradiol and drospirenone improves endothelium-dependent vasodilation in the coronary bed of ovariectomized spontaneously hypertensive rats[J].Braz J Med Biol Res,2016,49(1):4655.
12 Prifti E,Ademaj F,Baboci A,et al.Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation:a case report[J].J Med Case Rep,2015,9(1):540.
13王倩,徐荣良,秦永文,等.经皮介入封堵治疗70例冠状动脉瘘疗效分析-单中心经验[J].第二军医大学学报,2016,37(4):505-508.Wang Q,Xu RL,Qin YW,et al.Efficacy analysis of percutaneous intervention in the treatment of 70 cases of coronary arterial fistula:single-center experience[J].Journal of Second Military Medical University,2016,37(4):505-508.
14 Inaba Y,Yamaura H,Sato Y,et al.Side-hole catheter placement with fixation and embolization in common hepatic artery for hepatic arterial infusion chemotherapy(modified CHA-coil method)for patients with celiac artery stenosis or occlusion[J].Cardiovasc Intervent Radiol,2015,38(6):1621-1626.
15万俊义,张戈军,徐仲英,等.第Ⅱ代动脉导管未闭封堵器栓塞幼儿体肺侧支的临床应用[J].中国介入心脏病学杂志,2016,24(2):79-82.Wan JY,Zhang GJ,Xu ZY,et al.Clinical application of second-generation artery catheter oale closure embolism on body-pulmonary collateral vessel in toddlers[J].Chinese Journal of Interventional Cardiology,2016,24(2):79-82.
16杨婷,田野,刘晓桥,等.新型先天性心脏病动脉导管未闭介入封堵器[J].临床心血管病杂志,2016,32(1):12-14.Yang T,Tian Y,Liu XQ,et al.New congenital heart artery catheter unclosed interventional closure[J].Journal of Clinical Cardiovascular Disease,2016,32(1):12-14.
17杨舟,陈智,黄希勇,等.第二代Amplatzer动脉导管未闭封堵器经导管封堵冠状动脉瘘的临床观察[J].临床儿科杂志,2015,33(8):756-757.Yang Z,Chen Z,Huang XY et al.Clinical observation of second-generation Amplatzer arterial catheter for unclosed closure of coronary artery fistula by catheter[J].Journal of Clinical Pediatrics,2015,33(8):756-757.
18张戈军,徐仲英,蒋世良,等.第二代Amplatzer动脉导管未闭封堵器经股动脉逆行插管行室间隔缺损封堵术疗效评价[J].临床荟萃,2015,30(6):601-604.Zhang GJ,Xu ZY,Jiang SL,et al.Efficacy of second-generation Amplatzer arterial catheter for ventricular septal defect via a retrograde intubation of femoral artery[J].Clinical Meta-analysis,2015,30(6):601-604.
19吴文辉,杨呈伟,刘光锐,等.Ⅰ代动脉导管未闭封堵器在封堵膜部室间隔缺损中的应用[J].心肺血管病杂志,2015,34(3):160-163+170.Wu WH,Yang CW,Liu GR,et al.Application of generation I patent ductus arteriosus occluder in closing membranous ventricular septal defect[J].Journal of Cardiovascular Disease,2015(3):160-163+170.
2鞠樑,钱炜,李红,等.国产封堵器经导管介入封堵104例儿童先天性心脏病的临床分析[J].中华全科医学,2017,15(10):1735-1737+1801.JU L,Qian W,Li H,et al.Clinical analysis of congenital heart disease in children by catheter intervention:a report of104 cases[J].Chinese general medicine,2015,15(10):1735-1737+1801.
3王祥,陈智,肖云彬,等.第二代Amplatzer动脉导管未闭封堵器介入治疗小儿先天性心脏病[J].中国介入心脏病学杂志,2017,25(9):498-501.Wang Q,Chen Z,Xiao YB,et al.Role of second-generation Amplatzer arterial catheter in the treatment of congenital heart disease in children[J].China Journal of Interventional Cardiology,2017,25(9):498-501.
4周建华,单文军,黄建波,热娜.国产血管塞介入治疗儿童特殊类型动脉导管未闭疗效观察[J].海南医学,2017,28(15):2524-2525.Zhou JH,Shan WJ,Huang JB.Domestic angiocardial interventional therapy for children with special type of arterial catheter[J].Hainan Medicine,2011,28(15):2524-2525.
5 Do Carmo JM,da Silva AA,Wang Z,et al.Regulation of blood pressure,appetite and glucose by leptin after inactivation of insulin receptor substrate 2 signaling in the entire brain or in proopiomelanocortin neurons[J].Hypertension,2016,67(2):378-386.
6官文俊,许臣洪.动脉导管未闭封堵术后血小板减少临床分析[J].现代仪器与医疗,2017,23(3):14-15+20.Guan WJ,Xu CH.Clinical analysis of postoperative thrombrocytopenia after occluding patent ductus arteriosus[J].Modern Instruments&Medical Treatment,2013,23(3):14-15+20.
7 Cowie B,Kluger R,Rex S,et al.The relationship between pulmonary artery acceleration time and mean pulmonary artery pressure in patients undergoing cardiac surgery:An observational study[J].Eur J Anaesthesiol,2016,33(1):28-33.
8于波,孔祥清,张智伟,等.中国动脉导管未闭介入治疗指南2017[J].中国介入心脏病学杂志,2017,25(5):241-248.Yu B,Kong XQ,Zhang ZW,et al.Therapeutic Guidelines of Patent Ductus Arteriosus in China(2017 Edition)[J].Chinese Journal of Interventional Cardiology,2017,25(5):241-248.
9程真莉,李谧,吕铁伟,等.小儿动脉导管未闭介入封堵术后严重血小板减少临床分析[J].第三军医大学学报,2017,39(14):1486-1492.Chen ZL,Li M,Lv TW,et al.Clinical analysis of severe thrombocytopenia after interventional closure of pediatric arterial catheter[J].Journal of Third Military Medical University,2013,39(14):1486-1492.
10肖家旺,朱鲜阳,王琦光,等.经导管封堵主动脉窦瘤破入右心房的临床疗效及长期随访结果[J].中国介入心脏病学杂志,2017,25(3):127-132.Xiao JW,Zhua XY,Wang QG,et al.Clinical efficacy and long-term follow-up outcomes of catheter closing of aortic sinus tumor in right atrium[J].China Journal of Interventional Cardiology,2013,25(3):127-132.
11 Borgo MV,Claudio ER,Silva FB,et al.Hormonal therapy with estradiol and drospirenone improves endothelium-dependent vasodilation in the coronary bed of ovariectomized spontaneously hypertensive rats[J].Braz J Med Biol Res,2016,49(1):4655.
12 Prifti E,Ademaj F,Baboci A,et al.Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation:a case report[J].J Med Case Rep,2015,9(1):540.
13王倩,徐荣良,秦永文,等.经皮介入封堵治疗70例冠状动脉瘘疗效分析-单中心经验[J].第二军医大学学报,2016,37(4):505-508.Wang Q,Xu RL,Qin YW,et al.Efficacy analysis of percutaneous intervention in the treatment of 70 cases of coronary arterial fistula:single-center experience[J].Journal of Second Military Medical University,2016,37(4):505-508.
14 Inaba Y,Yamaura H,Sato Y,et al.Side-hole catheter placement with fixation and embolization in common hepatic artery for hepatic arterial infusion chemotherapy(modified CHA-coil method)for patients with celiac artery stenosis or occlusion[J].Cardiovasc Intervent Radiol,2015,38(6):1621-1626.
15万俊义,张戈军,徐仲英,等.第Ⅱ代动脉导管未闭封堵器栓塞幼儿体肺侧支的临床应用[J].中国介入心脏病学杂志,2016,24(2):79-82.Wan JY,Zhang GJ,Xu ZY,et al.Clinical application of second-generation artery catheter oale closure embolism on body-pulmonary collateral vessel in toddlers[J].Chinese Journal of Interventional Cardiology,2016,24(2):79-82.
16杨婷,田野,刘晓桥,等.新型先天性心脏病动脉导管未闭介入封堵器[J].临床心血管病杂志,2016,32(1):12-14.Yang T,Tian Y,Liu XQ,et al.New congenital heart artery catheter unclosed interventional closure[J].Journal of Clinical Cardiovascular Disease,2016,32(1):12-14.
17杨舟,陈智,黄希勇,等.第二代Amplatzer动脉导管未闭封堵器经导管封堵冠状动脉瘘的临床观察[J].临床儿科杂志,2015,33(8):756-757.Yang Z,Chen Z,Huang XY et al.Clinical observation of second-generation Amplatzer arterial catheter for unclosed closure of coronary artery fistula by catheter[J].Journal of Clinical Pediatrics,2015,33(8):756-757.
18张戈军,徐仲英,蒋世良,等.第二代Amplatzer动脉导管未闭封堵器经股动脉逆行插管行室间隔缺损封堵术疗效评价[J].临床荟萃,2015,30(6):601-604.Zhang GJ,Xu ZY,Jiang SL,et al.Efficacy of second-generation Amplatzer arterial catheter for ventricular septal defect via a retrograde intubation of femoral artery[J].Clinical Meta-analysis,2015,30(6):601-604.
19吴文辉,杨呈伟,刘光锐,等.Ⅰ代动脉导管未闭封堵器在封堵膜部室间隔缺损中的应用[J].心肺血管病杂志,2015,34(3):160-163+170.Wu WH,Yang CW,Liu GR,et al.Application of generation I patent ductus arteriosus occluder in closing membranous ventricular septal defect[J].Journal of Cardiovascular Disease,2015(3):160-163+170.