双导丝技术在新生儿危重肺动脉瓣狭窄治疗中的应用

The application of buddy-wire technique in the treatment of neonatal critical pulmonary stenosis

目的探讨应用双导丝技术介入治疗新生儿危重肺动脉瓣狭窄(CPS)的临床效果和安全性。方法回顾性分析2017年1月至2018年6月于青岛市妇女儿童医院出生并经双冠状动脉导丝建立介入轨道实施经皮球囊肺动脉瓣成形术(PBPV)的10例CPS新生儿(双导丝组)临床资料,其中男6例,女4例,平均年龄7.1(4~10)h;另随机选取10例经常规泥鳅导丝治疗的CPS新生儿作为对照组(常规组)。观察对比两组患儿手术时间、辐射暴露时间、辐射剂量、术中失血量、对比剂剂量、术中并发症、心脏重症监护室(CICU)住院时间、总住院时间等临床指标。结果两组PBPV术均顺利完成,双导丝组患儿平均手术时间、辐射暴露时间、辐射剂量、CICU住院时间、术中失血量、对比剂剂量、总住院时间均低于常规组。结论双导丝技术应用于新生儿CPS介入治疗安全有效,可显著缩短手术时间,较常规治疗可减少辐射暴露时间、辐射剂量及CICU住院时间,术中并发症少,利于维持循环稳定。

Objective To evaluate the clinical effect and safety of interventional therapy by using buddy-wire technique for critical pulmonary valve stenosis(CPS) in neonates.Methods The clinical data of 10 neonates with CPS(buddy-wire group),who were born in Qingdao Women and Children's Hospital and successfully received percutaneous balloon pulmonary valvuloplasty (PBPV) with buddy- wire technique during the period from January 2017 to June 2018,were retrospectively analyzed.The sick neonates included 6 male neonates and 4 female neonates,with an average age of 7.1 h (4-10 h).Other 10 neonates with CPS were randomly selected (control group) and received PBPV by using conventional guide wire.The time spent for operation,radiation exposure time,radiation dose,amount of intraoperative blood loss,used dose of contrast agent,intraoperative complications,length of stay in the cardiac intensive care unit(CICU),and total time of hospitalization were compared between the two groups.Results PBPV was successfully accomplished in all sick neonates of both groups.The mean time spent for operation,the radiation exposure time,the radiation dose,the length of stay in CICU,the amount of intraoperative blood loss,the used dose of contrast agent,and the total time of hospitalization in the buddy-wire group were lower than those in the control group.Conclusion Interventional therapy for neonatal CPS,buddy- wire technique is safe and effective.It can significantly shorten the time spent for operation,reduce radiation exposure time,radiation dose,hospitalization time in CICU,as well as incidence of intraoperative complications,which are beneficial to maintain the stability of circulation.