国产器材封堵儿童室间隔缺损682例并发症分析

Analysis of complications associated with interventional therapy in 682 children with ventricular septal defect using domestic occluder

目的 探讨应用国产器材封堵儿童VSD并发症的发生率、发生原因及防治措施。方法 将2004 年3月至2012年6月在河北医科大学第一医院行介入治疗的VSD患儿682例纳入本研究。其中男307例，女 375例；年龄2～13岁［（6.01±3.65）岁］；体质量10.1～54.6 kg［（14.5±6.7）kg］。患儿均应用国产封堵器进行介入治疗，对其术中、术后并发症发生情况进行观察和随访，并对临床资料进行回顾性分析。结果 术前经胸超声心动图检测VSD大小为1.9～11.2 mm［（5.5 ±2.4）mm］；术中左心室造影测量VSD 大小为1.9～12.1 mm［（6.1±2.3）mm］；所选封堵器为4.0～14.0 mm［（8.2±3.7）mm］。应用国产封堵器介入治疗儿童 VSD的总成功率为96.77%（660/682例），总并发症发生率为14.37%（98/682例），其中心脏并发症87例，血管并发症9例，其他并发症2例。严重并发症发生率为1.32%（9/682例），其中Ⅲ度房室传导阻滞4例，重度三尖瓣关闭不全2例，股动脉血栓 2例，封堵器脱落 1例，经相应治疗后无一例死亡。随访时间3～57个月［（29.1±26.7）个月］。结论 国产器材封堵儿童VSD安全、有效，并发症发生率低。术前正确判断、术中准确操作和术后严格随访是减少并发症发生的有效措施。

Objective To discuss the incidence,reasons,prevention and management of complications associ-ated with interventional therapy in children with ventricular septal defect （VSD） using domestic occluder. Methods Six hundred and eighty-two children with VSD, including 307 male and 375 female, aged 2-13 years old [ （averaged 6.01 ± 3.65） years old] ,weight 10.1 -54.6 kg[ averaged （14.5 ± 6.7） kg], were treated by interventional therapy in the First Hospital of Hebei Medical University from Mar. 2004 to Jun. 2012 and then enrolled in this study. All pa- tients were treated with domestic occluder. Intraoperative and postoperative complications were observed and followed-up. The clinical data were analyzed retrospectively. Results The size of VSD measured by transthoracic echocardio- graphy before occlusion was 1.9 - 11.2 mm [ averaged （5.5 ± 2.4） mm ]. The size of VSD measured by ventricular an- giography was 1.9-12.1 mini averaged （6.1 ±2.3） mm]. The diameter of occluders selected ranged from 4.0-14.0 mm [ averaged （ 8.2 ± 3.7 ）mm ]. The total success rate of interventional therapy was 96.77 % （660/682 cases） and the complication incidence was 14.37% （98/682 cases）. There were 87 cases of cardiac complication,9 cases of vascular complication and 2 cases of other complication. The incidence of serious complication was 1.32% （9/682 cases）, inclu- ding 4 cases of the third degree atrioventricular block,2 cases of severe tricuspid regurgitation,2 cases of femoral arte- rial thrombosis and 1 case of occluder shedding, and none of them died after relevant treatment. The follow-up time was 3 to 57 [ averaged （29.1 ~ 26.7 ） months ]. Conclusions Interventional therapy with domestic occluder is safe and effective for children with VSD. The incidence of complication is low. Correct judgement before operation, accurate ma- nipulation during operation and strict follow-up after operation are effective measures to decrease the complications.