儿童动脉导管未闭介入治疗单中心疗效及中长期随访观察

Intervention therapy of patent ductus arteriosus in children:a single-center observation and medium-long term follow-up

目的探讨儿童动脉导管未闭(PDA)介入治疗并发症的发生及原因。方法收集2004年1月1日至2019年1月1日行介入封堵治疗PDA患儿的临床资料,比较其封堵前后及随访1年的变化。结果共收集1408例患儿,男482例、女926例,中位月龄27.0(2.0~215.0)月,介入成功封堵1404例(99.72%)。PDA内径术前超声测值为3.3(0.1~18)mm,主动脉造影为2.2(0.1~18)mm;选用封堵器大小为(8.47±2.52)mm。术后24小时心脏超声复查有残余分流125例,血小板减少21例,心律失常31例,溶血2例,动脉血栓3例,假性动脉瘤4例,右髂总动脉破裂1例,右肾挫裂伤1例,封堵器移位4例,降主动脉狭窄1例,肺动脉狭窄1例,三尖瓣前瓣腱索断裂1例。多元logistic回归分析显示,女性、肺动脉高压严重程度递增、封堵器直径增大为术后发生残余分流的独立危险因素(P<0.05)。结论儿童PDA介入治疗安全、有效;PDA内径较大、合并中重度肺动脉高压患儿术后并发症发生率较高。

Objective To explore the complications and causes of interventional therapy for patent ductus arteriosus(PDA)in children.Methods The clinical data of children with PDA who underwent interventional occlusion from January 1,2004 to January 1,2019 were collected and the changes before and after occlusion and at the 1-year follow-up were compared.Results A total of 1408 children(482 boys and 926 girls)were included and a median age was 27.0(2.0~215.0)months,and 1404(99.72%)children were successfully closured by intervention.PDA was 3.3(0.1~18)mm measured by echocardiography,and was 2.2(0.1~18)mm measured by angiocardiography.The size of implanted device was(8.47±2.52)mm.Twenty-four hours after operation,there were 125 cases of residual shunt,21 cases of thrombocytopenia,31 cases of arrhythmia,2 cases of hemolysis,3 cases of arterial thrombosis,4 cases of pseudoaneurysm,1 case of right common iliac artery rupture,1 case of right renal contusion,4 cases of device shift,1 case of aorta coarctation,1 case of pulmonary artery stenosis and 1 case of anterior tricuspid valve chordae tendineae rupture.Multivariate logistic regression analysis showed that the female,the increasing severity of pulmonary hypertension and the increasing diameter of the occlusive device were independent risk factors for residual shunt after surgery(P<0.05).Conclusions The interventional therapy for PDA in children is safe and effective.Patients with PDA having large diameter and moderate to severe pulmonary hypertension had a higher incidence of postoperative complications.