改良室间隔缺损修补术治疗膜周室间隔缺损患儿的疗效及安全性

Efficacy and safety of modified ventricular septal defect repair in children with perimembranous ventricular septal defect

目的:比较改良室间隔缺损(ventricular septal defect,VSD)修补术与传统外科手术治疗膜周VSD的疗效及安全性。方法:选取2019年9月至2021年2月安徽省儿童医院接诊的100例膜周VSD患儿,随机分为改良组与对照组,各50例。其中改良组行改良VSD修补术治疗,对照组行传统外科手术治疗,于术后3、6、12个月进行随访。比较两组手术的一般情况,手术前后血清C反应蛋白(C-reactive protein,CRP)、白细胞计数(white blood cell count,WBC)、心肌肌钙蛋白I(cardiac troponinI,cTnI)、肌酸激酶同工酶(creatine kinaseisoenzy me,CK-MB)、左心室功能、肺动脉及主动脉瓣口血流速度水平,以及并发症发生率。结果:两组性别、年龄、体重、VSD缺损直径、美国麻醉师协会(American Society of Anesthesiologists,ASA)分级、美国纽约心脏病协会(New YorkHeart Association,NYHA)心功能分级等一般资料差异均无统计学意义(均P>0.05)。改良组主动脉阻断时间、体外循环时间、术中输血量、手术时间及术后住院时间均明显少于对照组(均P<0.05)。术后24h,改良组CRP、WBC、cTnI及CK-MB水平均显著低于对照组(均P<0.05)。术后3、6、12个月,改良组LVEF及主动脉瓣口血流速度均显著优于对照组(均P<0.05),LVEDD、LVSV及肺动脉瓣口血流速度均显著低于对照组(均P<0.05)。改良组术后残余分流、心脏瓣膜关闭不全、心律失常、房室传导阻滞发生率均明显低于对照组(均P<0.05)。结论:改良VSD修补术治疗膜周VSD患儿的疗效和安全性更好,可以减轻机体炎症反应和心肌损伤,改善患儿预后。

Objective: To compare the efficacy and safety of modified ventricular septal defect(VSD) repair and traditional surgery for treatment of perimembranous VSD. Methods: A total of 100 children with perimembranous VSD admitted to Anhui Children’s Hospital from September 2019 to February 2021 were randomly divided into a modified group and a control group, with 50 cases in each group. The modified group received modified VSD repair treatment, and the control group received traditional surgical treatment. The patients were followed up at 3, 6 and 12 months after the operation. The general condition, serum C-reactive protein(CRP), white blood cell count(WBC), cardiac troponin I(cTnI), creatine kinase isoenzyme(CK-MB), left ventricular function, pulmonary artery, and aortic valve blood flow velocity before and after the operation, and the incidence of complications were compared between the 2 groups. Results: There was no significant difference in gender, age, body weight, VSD defect diameter, American Society of Anesthesiologists(ASA) classification, and New York Heart Association(NYHA) cardiac function classification between the 2 groups(all P>0.05). The aortic clamping time, cardiopulmonary bypass time, intraoperative blood transfusion, operation time, and postoperative hospital stay were significantly less than those in the control group(all P<0.05). A?ter 24 h, the serum CRP, WBC, cTnI, and CK-MB levels in the modified group were significantly lower than those in the control group(all P<0.05). At 3, 6, and 12 months after the operation, LVEF and aortic valve flow velocity in the modified group were significantly higher than those in the control group(both P<0.05), while LVEDD, LVSV, and pulmonary valve flow velocity in the modified group were significantly lower than those in the control group(all P<0.05). The incidences of postoperative residual shunt, cardiac valve insufficiency, arrhythmia, and atrioventricular block in the modified group were significantly lower than those in the control group(all P<0.05). Conclusion: Modified VSD repair has better efficacy and safety in the treatment of perimembranous VSD in children, which can reduce the inflammatory response and myocardial injury, improve the prognosis of children.