不同年龄阶段单纯继发孔型房间隔缺损患者心脏腔室内径与临床症状变化特征

Characteristics of cardiac cavity diameter and clinical symptoms in patients with simple secondary hole atrial septal defect at different ages

目的分析不同年龄阶段单纯继发孔型房间隔缺损患者的临床资料,总结伴随年龄增长,房间隔缺损患者心脏腔室内径与其临床症状的变化特征。方法将北部战区总医院自2017年1月至2019年4月收治的213例单纯继发孔型房间隔缺损患者纳入患病组,其中,未成年患者(年龄<18岁)141例,成年患者72例;另将同期141例心脏超声正常的未成年人纳入正常组。再根据人体生长发育阶段,将研究对象分入年龄<1岁婴儿期组、1~3岁幼儿期组、4~6岁学龄前期组、7~12岁学龄期组、13~17岁青春期组、18~40岁青年组、41~65岁中年组、年龄>65岁老年组。比较正常组和患病组不同年龄阶段的心脏腔室内径及其临床症状、心房颤动发生情况。结果1~3岁幼儿期、4~6岁学龄前期、7~12岁学龄期、13~17岁青春期时,患病组右房舒张期最大横径、右室舒张期最大内径均大于正常组,差异有统计学意义(P<0.05);4~6岁学龄前期、7~12岁学龄期、13~17岁青春期时,患病组左室舒张末期内径均小于正常组,差异有统计学意义(P<0.05)。41~65岁中年患病组、年龄>65岁老年患病组左房舒张期最大内径均高于正常成年人,且年龄>65岁老年患病组高于41~65岁中年患病组,差异有统计学意义(P<0.05)。18~40岁青年患病组、41~65岁中年患病组、年龄>65岁老年患病组左室舒张末期内径与正常成年人比较,差异均无统计学意义(P>0.05)。18~40岁青年患病组、41~65岁中年患病组、年龄>65岁老年患病组右房舒张期最大横径、右室舒张期最大内径均高于正常成年人,差异有统计学意义(P<0.05)。18~40岁青年患病组、41~65岁中年患病组、年龄>65岁老年患病组的临床症状发生率均高于年龄<18岁患病组,且随着年龄增长,临床症状发生率呈上升趋势,组间比较,差异均有统计学意义(P<0.05)。41~65岁中年患病组、年龄>65岁老年患病组的心房颤动发病率均高于年龄<41岁患病组,且随着年龄增长,心房颤动发病率呈上升趋势,组间比较,差异有统计学意义(P<0.05)。结论随着年龄增长,单纯继发孔型房间隔缺损患者逐渐出现心腔内径增大并超过正常人群标准值。病变最初单纯累及右房、右室,之后进展至累及左房,导致左房、右房、右室同时增大,但左室舒张末期内径无明显增大。且随着年龄增长,临床症状和心房颤动的发生率也明显升高。

Objective To investigate the changes of cardiac chambers and clinical symptoms at different age groups in patients with secundum atrial septal defect(ASD).To investigate the clinical data of patients with simple secondary atrial septal defect at different age stages were analyzed.Methods A retrospective study was performed on 213 cases of patients with simple secondary atrial septal defect who were admitted from January 2017 to April 2019(disease group).Among them,there were 141 juvenile patients(aged less than 18 years old)and 72 adult patients.In addition,141 cases of minors with normal cardiac ultrasound during the same period were included in the normal group.According to the human growth and development stage,the research subjects were divided into the group whose age was less than 1 year old,the group whose age was 1-3 years old,the group whose age was 4-6 years old,the group whose age was 7-12 years old,the group whose age was 13-17 years old,the group whose age was 18-40 years old,the group whose age was 41-65 years old,and the group whose age was more than 65 years old.The clinical symptoms and atrial fibrillation of the normal group and the affected group were compared.Results At the ages of 1-3 years,4-6 years,7-12 years and 13-17 years,the right atrial diameter and right ventricular diameter of the affected group were all larger than those of the normal group,with statistically significant differences(P<0.05).At the ages of 4-6 years,7-12 years and 13-17 years,the left indoor diameter of the diseased group was all smaller than that of the normal group(P<0.05).The inner diameter of the left atrium of the disease group aged 41-65 and the disease group aged more than 65 were all higher than that of the normal adults,and the disease group aged more than 65 was higher than that of the disease group aged 41-65(P<0.05).There were no statistically significant differences in left indoor diameter between the young patients aged 18-40,the middle-aged patients aged 41-65,and the elderly patients aged more than 65(P>0.05).The right atrial diameter and right ventricular diameter of the 18-40 years old young patients,41-65 years old middle-aged patients,and more than 65 years old elderly patients were all higher than those of normal adults(P<0.05).The incidence of clinical symptoms in the disease group aged 18-40 years,the disease group aged 41-65 years,and the disease group aged more than 65 years were all higher than that in the disease group aged less than 18 years,and the incidence of clinical symptoms was on the rise with the increase of age(P<0.05).The incidence of atrial fibrillation in both the middle-aged group aged 41-65 years and the elderly group aged more than 65 years were higher than that in the group aged less than 41 years,and the incidence of atrial fibrillation was on the rise with the increase of age(P<0.05).Conclusion With the increase of age,patients with simple secondary atrial septal defect gradually increased the inner diameter of cardiac cavity and exceeded the standard value of normal population.The lesion initially involved only the right atrium and the right ventricle,and then progressed to the left atrium,resulting in simultaneous enlargement of the left atrium,the right atrium and the right ventricle,but no significant enlargement of the left ventricle diameter.The incidence of clinical symptoms and atrial fibrillation increased with age.