单纯超声引导在儿童经皮球囊肺动脉瓣成形术的价值

The value of ultrasound-guided percutaneous balloon pulmonary valvuloplasty in children

目的对比分析儿童经皮球囊肺动脉瓣成形术(PBPV)应用单一超声引导与X线引导的效果。方法回顾性分析2013年6月至2019年12月本院收治诊断为肺动脉瓣狭窄的90例患儿临床资料,按引导的方式不同分为研究组(采用单纯超声引导)和对照组(X线引导),每组45例。分析单纯超声引导PBPV中超声心动图图像,并对两组患儿手术操作时间、肺动脉跨瓣压差、肺动脉瓣血流速度等各项指标变化进行分析,观察并发症情况,探讨PBPV的有效性。结果研究组、对照组在术中操作时间上各为(34.60±8.00)min、(39.90±8.40)min,后者显著长于前者(P<0.05),同时在住院天数以及手术出血量者两项指标上,相较对照组,研究组均明显更低,但在手术费用上,两组未见明显差异(P>0.05);术后平均1至3个月的门诊随访,在肺动脉瓣血流速度与肺动脉瓣跨瓣压差这2项指标上,相比未手术时,两组手术后皆呈明显降低表现(P<0.05);在不良反应(包括心脏穿孔、三尖瓣损伤、外周血管损伤等)发生率方面,相较对照组(17.78%),研究组(4.44%)呈明显减少表现(P<0.05)。结论完全超声引导下的儿童PBPV不仅避免医护人员和低龄患儿受到辐射损伤,而且保持了传统经皮介入治疗微创、安全及疗效确切的优点。

Objective To explore the value of ultrasound-guided or x-ray guided percutaneous balloon pulmonary valvuloplasty(PBPV)in children.Methods The clinical data of 90 children with pulmonary stenosis in our hospital from June 2013 to December 2019 were retrospectively collected and analyzed.According to the way of guidance,all patients were divided into the research group(using simple ultrasound guidance,n=45)and the control group(using X-ray guidance n=45).The echocardiographic images during ultrasound-guided PBPV were analyzed,and the changes of various indexes such as operation time,pulmonary artery transvalvular pressure difference and pulmonary valve blood flow velocity were analyzed to observe the complications and explore the effectiveness of PBPV in the two groups.Results The operation time of children in the control group was longer than that in the research group(P<0.05),while the hospitalization days and bleeding volume of children in the research group were significantly lower than those in the control group.There was no significant difference in the operation cost between the two groups(P>0.05).The average postoperative follow-up in clinic was 1-3 months.The postoperative pulmonary valve blood flow velocity and pulmonary artery transvalvular pressure difference significantly decreased compared with pre-operation in both groups.The incidence of adverse events such as peripheral vascular injury,tricuspid valve injury,and cardiac perforation were significantly lower in the research group than those in the control group(P<0.05).Conclusion Ultrasound-guided PBPV in children not only protects medical staff and young children from radiation damage,but also maintains the advantages of traditional percutaneous intervention,which is minimally invasive,safe and effective.