肺血减少型复杂先心病姑息术后内科介入治疗的临床效果分析word论文.docxVIP

张术取得成功，一例于球囊扩张时出现心律不齐、间断室性早搏，暂未处理，密切监测心电、血压及血氧情况，于术后12小时心律失常消失。余患儿无术中及术 后并发症发生，其中11例行肺动脉瓣球囊扩张术，4例行肺动脉分支球囊扩张术， 1例存在III°AVB介入术中给予起搏器植入，1例行肺动脉球囊扩张术后三月复查 时发现左肺动脉起始部仍明显狭窄而行左肺动脉球囊扩张术。术后即刻疗效观： 15例患儿术后即刻右心导管及造影检查数据显示术后跨肺动脉瓣压力阶差（Pulmonary transvalvular gradient，PTG）、右室收缩压（Right Ventricular Systolic Pressure；RVSP）及SaO2较术前明显变化，差异有统计学意义(P＜ 0.05)。随访时间3.2月（1-12）,在随访过程中心脏彩超或CT检查发现患儿肺动 脉瓣、主肺动脉、左右肺动脉、Nakata指数、Mcgoon比值、PTG等均较术前有明 显改善（P＜0.05）。已有4人分别于球囊扩张术后40天、5月、7月和1年，因肺 动脉发育较好达到根治标准而最终行根治手术，术后患儿生命体征平稳，随访心 功能及经皮血氧饱和度均在正常值范围，青紫明显改善，活动量较前有明显提高。 余患儿仍在随访中，病情平稳，紫绀较前有所减轻，胸片肺血及活动耐量较前有 所增加，所有患儿心功能评分（NYHA）较术前改善，SaO2维持在88%左右（未吸 氧下)。结论 ：经皮肺动脉瓣或肺动脉球囊扩张术对肺血减少型复杂先心病外科姑息术 后介入治疗能有效地增加患者前向肺血流，促进其肺血管发育，改善心室功能， 为进一步的根治治疗创造一定的条件，显示了较好的临床效果。同时减少外科多 次开胸风险及并发症，降低医疗费用，与外科姑息手术相比显示了其独特的优势。 关键词： 法洛四联症姑息术后经皮肺动脉球囊扩张术疗效随访AbstractBackground:Decreased pulmonary blood type of complex congenital heart disease accounted for 11.5% of congenital heart disease,and It is a difficult treatment to cardiac surgery.Merging pulmonary hypoplasia or pulmonary valve of severe stenosis of pulmonary blood type to reduce complex congenital heart disease of pul-monary blood supply to the pul -monary blood flow, rely on very little ahead of ische-mia hypoxia serious, could be life threatening.Many children need to have a B-T shunt or Glenn surgery and other palliative surgery increased pulmonary blood firstly, relieve symptoms of hypoxia,pulmonary vascular bed and improve ventricular func-tion, in order to achieve effect a radical cure treatments or physiological condi-tion.However,some patients due to shunt stenosis resulting in longer follow-up time of hypoxemia, poor pulmonary vascular development, fail to cure the condition,or need a secondary shunt surgery, increasing the risk of surgery.How to further improve these patients pulmonary vascular development and increase the chance of cure of the patient is the direction of research efforts in recent years,both in domestic and foreign scholars. This study intends to reduce pulmonary