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|本期目录/Table of Contents|

经皮穿动脉导管堵塞术的临床应用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
1998年第2期
页码:
81-83
栏目:
论著
出版日期:
1998-03-01

文章信息/Info

Title:
Clinical use and complication management of percutaneous closure of patent ductus arteriosus
作者:
杜修海 张卫泽 张明旭 胡静泠 秦 勉 王艳春 刘春梅 张爱君
兰州军区总医院心内科 兰州 730050
Author(s):
Du Xiuhai;  Zhang Weize;  Zhang Mingxu ;  Hu Jingling ;  Qin Mian;  Wang Yianchum ;  Liu Chumei;  Zhang Aijun
Department of Cardiology, Lanzhou General Hospital of Lanzhou Command, Lanzhou 730050
关键词:
动脉导管未闭　泡沫塞子　动脉导管未闭堵塞术
Keywords:
ductur arteriosus;  patent　foam plug　closure of patent ductus arteriosus
分类号:
-
DOI:
-
文献标识码:
-
摘要:
18例动脉导管未闭(PDA)患者, 年龄7岁～ 47岁, 平均23.2±2.6岁, 对其采用改进的Porstmann法实施经皮穿刺堵塞术。以彩色多普勒, 气囊导管探测未闭导管的大小, 结合导管卡尺测量塞子并实施堵塞术。14例关闭成功, 其血流动力学各参数均明显改善或恢复正常。随访1年～ 7年无栓子移位或再分流发生。在未闭导管关闭后约30 min时易出现心动过缓, 血压下降甚至发生休克。早期处理可避免这一并发症。此方法易于确定未闭导管的实际内径, 可避免单凭造影测量的误差, 疗效可靠。失败4例: 1例未闭导管呈反漏斗型, 1例塞子过小, 脱入肺动脉, 经送至股静脉并切开取出; 另2例系股动脉太细而不能送入选定的塞子。1例因压迫过度发生股动脉血栓, 经手术去除。
Abstract:
By using improved Porstmann method, the percutaneous closure of patent ductus arterious (PDA ) was performed in 18 patients aged from 7 to 47 (mean 23.3±12.6) years.The colour Doppler, balloon exploration of the defect and a catheter scale examination of the foam plug were used for choice of patients, and for measurment of PDA dilated diameter and plug closure1 Successful occlusion was achieved in 14 cases.The shunts from aotic artery to pu lmonary artery were blocked as soon as the plug was fixed in PDA.The pressure of pulmonary artery and right ventricle decreased (3.2±0.9 vs 1.5±1.3; 2.6±0.8 vs 1.4±0.9 kPa, respectively, P < 0.01) and the cardiac index increased significantly (2.7±0.8 vs 3.8±0.6, P < 0.05) after occlusion1 No plug displacement and recanalzation was found in 1～ 7 year′s follow-up.The bradycardia, hypotension or even shock would occure at the time of about 30 minutes after the closure, but this complication can be avoided by early managemet.The management was unsuccesful in four patients.Plug dislocation into pulmonary artery through inverse funnel shaped PDA in two.The plug was pushed into the femoral vein with a catheter and taken off from there th rough an incision of the vein.In the other two the femoral artery was thiner than PDA and the chosen plug could not be placed into the artery.So the choice of suitable patient was important.

参考文献/References

［1］Porstmann W , Wierny L , Warnke H.Closure of the persistent ductus arteriosus without tho racotomy.Ger Med Mon, 1967; 129: 203.

［2］张卫泽, 杜修海.先天性心脏病的非开胸导管治疗进展.国外医学心血管分册.1994; 15: 227.

［3］Sengen R, Jinxing L , Kang K, et al.Percutaneous balloon exploration and plug closure of ductus arteriosus.Chin Med J , 1991; 104: 343.

［4］Rashkind WJ , Mullins CE, Hellendrand WE.Nonsurgical closure of patent ductus arteriosus: Clinical application of the Rishkind occluder system.Circulation, 1987;75: 583.

［5］Lock JE, Cockerham JK, Keane JE, et al. Transcatheter umbrella closure of congenital heart defects.Circulation, 1987; 75: 593.

［6］陈明哲, 胡旭东主编.介入性心脏病学, 第1版.北京:北京医科大学, 中国医科大学联合出版社, 1992: 293～308.

［7］Lioyd TR, Fedderly T , Mendelsohn AM , et al.Transcatheter occlusion of patent ductus arterio sus with gianturco coils.Circulation, 1993; 88: 1412.

［8］Akagi T , Hashino K, Sugimura T , et al.Coil occlusion of patent ductus arteriosus with detachable coils.AHJ ,1997; 134 (3) : 538.

［9］Rao PS, Sideris EB, Haddad J , et al.Transcatheter occlusion of patent ductus arteriosus with adjustable buttoned device.Circulation, 1993; 88: 1119.

［10］张宁仔, 杜日映, 主编.心血管科医师进修必读, 第1版, 北京: 人民军医出版社, 1996: 275～ 285.

备注/Memo

备注/Memo:
(收稿1997-03-11　修回1998-01-10)
更新日期/Last Update: 1998-03-01