经食道超声引导下经胸微创房间隔缺损封堵术治疗继发孔中央型房间隔缺损的效果

Efficacy of transesophageal ultrasound-guided minimally invasive transcatheter closure of atrial septal defect for secondary central atrial septal defect

目的观察经食道超声引导下经胸微创房间隔缺损封堵术治疗继发孔中央型房间隔缺损的临床效果。方法 98例继发孔中央型房间隔缺损患者,均行经食道超声引导下经胸微创房间隔缺损封堵术治疗。观察患者围术期指标及术后并发症发生情况。结果所有患者均顺利完成手术,手术时间(44. 2±6. 5) min,术后呼吸机辅助时间(232. 2±57. 3) min,ICU停留时间(16. 2±7. 5) h,术后住院时间(4. 5±0. 8) d,切口大小(4. 4±0. 9) cm,胸腔引流液(67. 6±11. 2) ml。术后发生心律失常4例,出血1例,肺不张1例,无残余分流、封堵器脱落、移位及死亡病例。患者术后肺动脉压力及纽约心脏病协会心功能分级均低于术前(均P <0. 05)。结论经食道超声引导下经胸微创房间隔缺损封堵术治疗继发孔中央型房间隔缺损疗效确切,安全性高,可有效改善患者心功能。

Objective To observe the clinical efficacy of transesophageal ultrasound-guided minimally invasive transcatheter closure of atrial septal defect for secondary central atrial septal defect.Methods A total of98patients with secondary central atrial septal defect underwent transesophageal ultrasound-guided minimally invasive transcatheter closure of atrial septal defect.Perioperative indicators and postoperative complications of the patients were observed.Results All of the patients accomplished the operation,with the operation duration of44.2±6.5minutes,the postoperative ventilator assisted duration of232.2±57.3minutes,the ICU stay of16.2±7.5hours,the postoperative hospital stay of4.5±0.8days,the incision size of4.4±0.9cm,and the thoracic drainage fluid volume of67.6±11.2ml.After operation,arrhythmia occurred in4cases,bleeding in1case,atelectasis in1case,no cases suffered from residual shunt or occluder abscission/displacement,and no cases died.The postoperative pulmonary artery pressure and New York Heart Association cardiac function scores were lower than those before operation(all P<0.05).Conclusion Transesophageal ultrasound-guided minimally invasive transcatheter closure of atrial septal defect can improve the cardiac function of the patients with secondary central atrial septal defect,having a definite efficacy and high safety.