肺血减少型复杂先天性心脏病姑息术后介入治疗的临床效果研究

Effect of interventional therapy for patients with complex congenital heart disease with diminished pulmonary blood disease after palliative treatment

目的：探讨肺血减少型复杂先天性心脏病姑息术后,应用经皮球囊扩张术治疗的临床效果。方法：收集自2012年7月至2015年2月间,肺血减少型复杂先心病姑息手术（体-肺动脉分流或双向Glenn术）后1年肺动脉发育仍未达根治条件的病例共23例,男性14例、女性9例,年龄1.3-13.0岁（中位年龄3.1岁）,体质量8.0-48.0kg,平均（17.9±7.7）kg,身高72.0-173.0cm,平均（97.8±23.6）cm,经皮血氧饱和度（Sa O2）74%-89%,平均（80.0±7.0）%。术前常规行超声心动图、心电图、胸部X线、心导管和造影检查,所有病例行经皮球囊肺动脉瓣或肺动脉扩张,于术后1个月、3个月、6个月及1年进行随访。评价经皮球囊肺动脉扩张术治疗肺血减少型复杂先心病姑息术后肺动脉发育仍未达根治条件的患儿的临床效果。结果：所有患儿均成功行介入治疗,无严重并非症。23例患儿术后即刻跨肺动脉瓣压力阶差（PTG）、右心室收缩压（RVSP）较术前明显减少,Sa O2较术前明显升高,差异有统计学意义（P〈0.05）。在随访过程中经超声心动图或CT检查发现患儿肺动脉瓣、主肺动脉、Nakata指数、Mc Goon比值、PTG等均较术前有明显改善（P〈0.05）。12例患儿因肺动脉发育较好达到根治条件而最终行根治手术,恢复良好。9例行未跨环手术,3例行跨环手术。余患儿仍在随访中,病情平稳,发绀较前有所减轻,活动耐量较前有所增加。结论：经皮肺动脉瓣或肺动脉球囊扩张术可有效增加肺血减少型复杂先心病外科姑息术后患儿前向肺血流,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条件。

Objective： To explore of interventional therapy for patients with complex congenital heart disease with diminished pulmonary blood after palliative treatment. Methods： 23 patients（ 14 males and 9 females） with complex congenital heart disease with diminished pulmonary blood disease are collected from July2012 to February 2015,who had palliative treatment such as body-pulmonary shunt or bi-directional Glenn shunt 1 year ago,but still not to reach the standard to corrective surgery,with aged is 1. 3- 13. 0 years,average of（ 4. 3 ± 3. 4） years,weight is 8. 0- 48. 0 kg,averag of（ 17. 9 ± 7. 7） kg,height is 72. 0- 173. 0cm,average of（ 97. 8 ± 23. 6） cm,systemic oxygen saturation（ Sa O2） is 74%- 89%,average of（ 80. 0 ± 7. 0） %. After echocardiogram,electrocardiogram,chest X-ray,cardiac catheterization and angiography completed,the pulmonary valve or pulmonary balloon dilatation was performed in all cases and the efficacy was evaluated at immediate procedural,1 month,3 months,6 months,1 year. Results： All patients were successfully carried out intervention therapy,no intraoperative and postoperative complications were found. The immediately results of 23 casesshow that pulmonary transvalvular gradient（ PTG）,Right Ventricular Systolic Pressure（ RVSP） and Sa O2 have a significant change compared with the preoperative. The difference was statistically significant（ P〈0. 05）. The main pulmonary artery,Nakata index,Mc Goon ratio,PTG（ P〈0. 05） was a significant improvement on follow up. Twelve people have already undergone corrective surgery. Nine of the patients who underwent corrective surgery did not required transannular patch. The rest of children are still on follow up,smooth condition,activities tolerance increased. Conclusion： Percutaneous pulmonary artery balloon dilatation for patients with complex congenital heart disease with diminished pulmonary blood after palliative treatment can promote pulmonary vascular development,improve ventricular function,in order to create the conditions for radical treatment.