胸壁微创封堵术治疗膜周部室间隔缺损的疗效观察

Effect of minimally invasive thoracic wall occlusion on patients with perimembranous ventricular septal defect

目的探讨胸壁微创封堵术与开胸手术对膜周部室间隔缺损(PVSD)患儿凝血功能及应激指标的影响。方法选取2015年1至12月新疆医科大学第一附属医院收治的PVSD患儿68例,随机分为研究组和对照组,研究组应用胸壁微创封堵术治疗,对照组应用开胸手术治疗。结果手术前两组患者的凝血指标比较无显著差异(t值分别为1.320、1.030、2.210、2.120,均P>0.05),手术后两组均出现一定变化,差异均有统计学意义(t值分别为7.464、5.436、7.532、8.543、9678、10.236、10.113、12.342,均P<0.05)。手术后研究组各项凝血指标水平显著优于对照组(t值分别为11.082、10.082、10.423、9.877,均P<0.05),手术前两组患者的应激指标皮质醇(Cor)及血糖(Glu)水平比较差异无统计学意义(t值分别为1.029、1.097,均P>0.05),手术后研究组各项凝血指标水平显著优于对照组(t值分别为11.082、10.082,均P<0.05)。结论同开胸手术比较而言,PVSD患者应用胸壁微创封堵术能够改善治疗效果,维持凝血功能稳定并降低应激指标变化情况。

Objective To investigate the effect of minimally invasive thoracic wall occlusion and thoracotomy on coagulation function and stress index in children with perimembranous ventricular septal defect（PVSD）.Methods Sixty-eight children with PVSD were enrolled in the First Affiliated Hospital of Xinjiang Medical University from January to December in 2015.They were randomly divided into study group treated with minimally invasive thoracic wall occlusion and control group treated with thoracotomy.Results Before surgery blood clotting indexes of two groups were not significantly different（t value was 1.320,1.030,2.210 and 2.120,respectively,all P〈0.05）,but after surgery a certain changes occurred in two groups（t value was 7.464,5.436,7.532,8.543,9678,10.236,10.113 and 12.342,respectively,all P〈0.05）.After surgery,the levels of coagulation indexes in study group were significantly better than those of the control group（t value was 11.082,10.082,10.423 and 9.877,respectively,all P〈0.05）.Stress indexes of cortisol（Cor）and blood glucose（Glu）level of two groups before surgery were not significantly different（t value was 1.029 and 1.097,respectively,both P〈0.05）,but after surgery the coagulation indexes were significantly better in the study group than in the control group（t value was 11.082 and 10.082,respectively,both P〈0.05）.Conclusion Compared with thoracotomy,PVSD patients can improve curative effect and maintain stable coagulation function and decrease changes in stress index with minimally invasive thoracic wall occlusion.