先天性心脏病患者姑息术后介入治疗效果观察

Curative effect of interventional therapy for patients with congenital heart disease after palliative operation

目的探讨肺血减少型复杂先天性心脏病患者进行姑息手术后辅助介入治疗的临床疗效。方法选择2016年6月至2017年10月四川省人民医院和西南医科大学附属医院收治的98例肺血减少型复杂先天性心脏病姑息术后未根治患者,根据治疗方法的不同分为保守治疗组与姑息手术组,每组49例,对比2组患者临床疗效。结果 2组患者治疗前后超声心动图相关参数(PTG、RVSP、PASP)、肺动脉发育指标(McGoon比值、Nakata指数、肺动脉瓣环径)、心功能相关生化指标(CK-MB、LDH、肌红蛋白)含量的差异均有统计学意义(P <0. 05); 2组患者出院后1个月与出院后3个月比较,超声心动图相关参数、肺动脉发育指标、心功能相关生化指标含量差异具有统计学意义(P <0. 05);姑息手术组PTG、RVSP、心功能相关生化指标含量显著低于保守治疗组,PASP指标含量、McGoon比值、Nakata指数、肺动脉瓣环径显著高于保守治疗组;不同时点比较,2组患者随着时间迁移PTG、RVSP指标含量、心功能相关生化指标含量显著下降,PASP指标含量、McGoon比值、Nakata指数、肺动脉瓣环径显著上升。结论外科姑息手术后进行介入治疗,对肺血减少型复杂先天性心脏病有明显的治疗价值,并可有效促进肺血管发育,改善心室功能,减少术后并发症,有较高的安全性。

Objective To explore the curative effect of interventional therapy for patients with pulmonary hematopenia complicated congenital heart disease after palliative operation. Methods From June 2016 to October 2017, 98 patients with pulmonary hematopenia complicated congenital heart disease who were admitted to Sichuan provincial people′s hospital and affiliated hospital of southwest medical university without radical treatment after palliative surgery were selected. According to different treatment methods, they were divided into the conservative treatment group and the palliative surgery group, with 49 cases in each group. Observed the clinical efficacy of the two groups. Results Echocardiography parameters (PTG, RVSP, PASP),pulmonary artery development indicators (McGoon ratio, Nakata index, pulmonary valve ring diameter), and cardiac function related biochemical indicators content (CK-MB,LDH,myoglobin) before and after treatment in the two groups were of significant difference ( P <0.05);and there were significant differences at 1 month and 3 months after discharged from the hospital as well ( P <0.05). In the palliative surgery group, the content of PTG, RVSP and biochemical indexes related to cardiac function was significantly lower than those in the conservative treatment group, and the content of PASP index, McGoon ratio, Nakata index and pulmonary valve diameter were significantly higher than those in the conservative treatment group. With the passage of time, the contents of PTG, RVSP and biochemical indexes related to cardiac function in the two groups decreased significantly, while the contents of PASP, McGoon ratio, Nakata index and pulmonary valve annulus diameter increased significantly. Conclusion Palliative surgery after interventional therapy for patients with congenital heart disease is of remarkable clinical effect,and it can effectively promote the development of pulmonary vascular, improve the ventricular function, reduce the postoperative complications, with higher security.