高海拔地区动脉导管未闭藏族患者介入治疗的疗效分析

Evaluation of interventional therapy in high - altitude Tibetan patients with patent ductus arteriosus

目的探讨高海拔缺氧地区动脉导管未闭(patent ductus arteriosus,PDA)藏族患者介入手术治疗效果。方法 9例来自西藏、生长环境均在海拔3500 m以上的藏区PDA患者。年龄3～21岁,平均(10.4±5.5)岁,入我院行超声心动图检查确诊后行介入治疗。其中合并轻度肺动脉高压(pulmonary hypertension,PH)1例,中度肺动脉高压1例,重度肺动脉高压2例。手术皆采用国产封堵器在降主动脉造影下行介入封堵。结果除1例试封堵失败转外科外,余8例手术均取得成功。2例重度PH患者术前测肺动脉收缩压分别为78、83 mmHg,术后即刻测肺动脉收缩压降至16、48 mmHg,中度及轻度PH患者术后即刻肺动脉压均降至正常。术后2例出现一过性血小板减少症,2例存在少量残余分流,无严重肺部感染及封堵器脱落等严重并发症。结论长期生活在高海拔低氧地区可逆性PH的PDA患者经导管介入封堵治疗安全有效。

Objective To study the efficacy of interventional operations in high - altitude patients with patent ductus arteriosus （PDA）. Methods The sample consisted of 9 Tibetan patients who were living at an altitude of over 3500 meters. Their age ranged from 3 to 21 years. Echocardiography was performed, which identified 1 case of patent ductus arteriosus （PDA） associated with severe subaortic stenosis （AS）, in whom interventional therapy was not successful. 8 cases, after diagnostic confirmation, received arterial catheter interventional treatment, one of whom was complicated by mild pulmonary hypertension （PH） , another one by moderate pulmonary hypertension, and two by severe pulmonary hypertension. The operation proceeded with the domestic occluder in transcatheter closure under the descending aorta angiography. Results In two patients with severe pulmonary arterial hypertension whose preoperative pulmonary artery pressure was 78mmHg and 83mmHg respectively, the postoperative pulmonary arterial pressure fell to 16 and 48mmHg but decreased to normal in patients with moderate and mild pulmonary hypertension. On the second day after operation, those two patients developed transient thrombocytopenia, two patients had a small amount of residual shunt, without severe puhnonary infection large residual shunt, coarctation of the aorta, or other serious complications. Conclusions Interventional treatment is safe and effective for patients with patent ductus arterionsus and reversibile pulmonary hypertension living in high - altitude regions.