胸部超声联合食管超声引导下经皮微创封堵术治疗房间隔缺损的临床观察

Clinical observation of percutaneous minimally invasive closure guided by transthoracic echocardiography combined with transesophageal echocardiography in the treatment of atrial septal defect

目的观察胸部超声(TTE)联合食管超声(TEE)引导下经皮微创封堵术治疗房间隔缺损的效果。方法抽取2019年1月至2020年6月南阳市中心医院收治103例房间隔缺损患者,告知患者与家属本研究所用方案后由患者家属商量后选择引导方法,其中45例选择TTE单独引导的患者作为对照组,58例选择TTE联合TEE引导的患者作为观察组。两组均行经皮微创封堵术治疗。术后行TTE复查,比较两组一次封堵成功率;分别于术前、术后1个月行TTE检查,比较两组心功能指标;比较两组术后并发症发生情况。结果观察组一次封堵成功率(98.28%,57/58)高于对照组(84.44%,38/45),P<0.05。两组术后1个月左心房前后径、右室内径、左心室舒张末期内径均较术前降低,左心室射血分数较术前升高,组内比较差异有统计学意义(P<0.05);但组间各心功能指标水平比较差异未见统计学意义(P>0.05)。对照组与观察组并发症发生率(4.44%,2/45比1.72%,1/58)比较差异未见统计学意义(P>0.05)。结论TTE联合TEE引导下经皮微创封堵术治疗房间隔缺损的一次封堵成功率高,利于患者心功能恢复,且并发症少,安全性好。

Objective To observe the effect of percutaneous minimally invasive occlusion guided by transthoracic echocardiography(TTE)combined with transesophageal echocardiography(TEE)in the treatment of atrial septal defect(ASD).Methods A total of 103 patients with ASD treated in Nanyang Central Hospital from January 2019 to June 2020 were selected.Patients and their family members deliberated together and made selection of guiding method,after being aware of protocols used in the study.Among them,45 cases who chose TTE guidance alone were set as the control group,and 58 cases who chose TTE combined with TEE guidance were set as the observation group.Both groups were treated by percutaneous minimally invasive closure.TTE re-examination were required after surgery.The success rate of one-time sealing of the two groups were compared.TTE examination was performed before surgery and 1 month after surgery.And the heart function indexes of the two groups were compared,and the postoperative complications were compared between the two groups.Results The success rate of one-time blocking in the observation group(98.28%,57/58)was higher than that in the control group(84.44%,38/45),P<0.05.The anterior-posterior diameter,right ventricular diameter,and left ventricular end-diastolic diameter of the two groups were lower than that before operation,and the left ventricular ejection fraction was higher than that before operation(P<0.05).However,there was no significant difference in cardiac function indexes between the two groups(P>0.05).There was no significant difference in the incidence of complications between the control group(4.44%,2/45)and the observation group(1.72%,1/58),P>0.05.Conclusions TTE combined with TEE guided percutaneous minimally invasive closure in the treatment of ASD has a high success rate,which is beneficial to the recovery of cardiac function of the patient,and has fewer complications and good safety.