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|本期目录/Table of Contents|

经导管国产封堵器与心脏直视手术治疗房间隔缺损的对比研究(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第3期
页码:
285-287
栏目:
介入治疗
出版日期:
2005-05-05

文章信息/Info

Title:
Comparison of surgery versus domesticmade ASD occluder device implantation.in the closure of atrial septal defects
作者:
代政学1;  郭游行3;  樊川民4; 张玉顺1;  王海昌1;  贾国良1;  李寰; 刘建平1; 张军2; 李军2;  王小燕1
第四军医大学西京医院:1.心血管内科, 2.超声科, 陕西 西安 710032；3.富平县医院心内科；4.咸阳市第二医院心内科
Author(s):
DAI Zhengxue1;  GUO Youxing3; FAN Chuanmin4;  ZHANg Yushun1;  WANG Haichang1;  JIA Guoliang1; LI Huan1; LIU Jianping1; ZHANG Jun2;  LI Jun2;  WANG
1.Cardiology Department of Xijing Hospital, Fourth Military Medical University, Xi′an,Shaanxi 710032,China
关键词:
封堵;  心脏直视手术;  房间隔缺损
Keywords:
domesticmade ASD occluder;  atrial septal defect; surgery
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 比较经导管封堵与心脏直视手术治疗继发孔型房间缺损(ASD)的疗效和并发症。方法 采用相同的入选标准，从2001年在我院接受治疗的继发孔型ASD患者，选择符合条件的患者共378例。外科手术组156（男51，女105）例。介入治疗组222（男86，女136）例。外科手术组和介入治疗组年龄分别为22±16和24±17岁（P>0.05）；ASD大小分别为16．46±5．04 mm和18．87±6．06 mm(P>0.05)。介入治疗组和外科手术组中各有2例患者既往有阵发性心房颤动病史， 各有1例患者有阵发性室上性心动过速病史各有3例患者为多孔型。结果 全组无死亡。介入治疗组和外科手术组的成功率分别为99．1％和100％（P>0.05），术后残分流率分别为0.91％和0．64％（P>0.05），均为少量。总并发症发生率分别为5．0％和35．3％（P<0．05）；主要并发症发生率分别为0．9％和3．2％（P<0．05），次要并发症发生率分别为4．1％和32．1％（P<0．01）。介入治疗组中无1例患者需要输血，外科手术组中76例患者需要输血，平均输血量为547±171 ml。两组治疗费用相似，分别为2456±542和2236±742元（P>0.05）存在。介入治疗组和外科手术组的住院天数分别为4±2 d和13±6 d（P<0．01)。结论 和心脏直视手术治疗相比较, 经导管封堵ASD痛苦更小，恢复更快、并发症更少且无需体外循环及输血，值得推广应用，心脏直视手术应作为经导管封堵ASD的补充手段。
Abstract:
AIM To compare effectiveness, complications, and cost of domesticmade ASD occluder with surgical in atrial septal defect (ASD) closure. METHODS We prospectively compared closure rates , complication rates, regression of right ventricular dilatation (up to one year postprocedure), cost, inpatient stay, and home convalescent time in 378 patients with secundum atrial septal defects: 156 cases (22±16 years) were treated surgically and 222 cases(24±17 years) were treated by percutaneous domesticmade ASD septal occluder . RESULTS domesticmade ASD occluder closure was successful in 200 of 222 (99.1%) patients. Surgical closure was successful in all 222 cases. Cardiac complications affecting management occurred in two (0．9％) of the domesticmade ASD occluder group (one procedural failures, one stoke) and 5 of 156 (3．2%) surgical patients (one pericardial pain, 2 global pericardial effusion requiring drainage, and two patient with anaemia requiring haematinics) . There were complications that did not affect management in a further 45 of 156 surgical patients and 9 of 222 domesticmade ASD occluder group. There was no significant difference in regression of right ventricular dilatation by six months postprocedure (median right ventricular end diastolic diameter decrease: domesticmade ASD occluder group 17.5%, surgical group 15.1%). Blood products were administered to 76 patients in the surgical group and no patient in the device group (P< 0.01). Both hospital stay and home convalescent times were significantly shorter after domesticmade ASD occluder closure (median hospital stay: domesticmade ASD occlude 3．57±1．89 days, surgery 13．41±5．74 days; median convalescent time: domesticmade ASD occluder two weeks, surgery 6 weeks). Median cost was similar for both groups (domesticmade ASD occluder RMB2456±542, surgical RMB 2236±742, P>0.05). CONCLUSION Transcatheter closure of secundum atrial septal defects with the domesticmade ASD occluder device has the advantage of fewer complications, shorter hospitalization, and reduced need of blood products. Nonetheless, the surgeon's ability to close any atrial septal defect regardless of its size or location remains an important advantage of surgery.

参考文献/References

［1］Masura J,Gavora P,Formanek A,et al. Transcatheter closure of secundum atrial septal defects using the new selfcentering amplatzer septal occluder: initial human experience［J］. Cathet Cardiovasc Diagn, 1997，42(4):388-393.

［2］张玉顺， 贾国良. 应用Amplatzer封堵器治疗房间隔缺损［J］. 心脏杂志 ,2000,12(5):379-381.

［3］张玉顺，贾国良，刘建平，等. 应用Amplatzer封堵器治疗房间隔缺损疗效评价［J］. 心脏杂志，2001,13(6):476-478.

［4］张玉顺， 张军。经胸超声心动图监视下应用Amplatzer封堵器治疗房间隔缺损［J］. 心脏杂志,2001,13(5):393-395.

［5］代政学，张玉顺．李寰，等. 房间隔缺损并发畸形的介入治疗［J］. 心脏杂志,2002,14(2):152-156.

［6］代政学 ，张玉顺 ，吴栋梁，等. 房间隔缺损并发心房纤颤患者应用Amplatzer伞封堵房缺后心房纤颤的电复律治疗［J］. 心脏杂志,2001,13(5):391-393.

［7］戴汝平， 刘延玲. 应用Amplatzer封堵器介入治疗房间隔缺损疗效评价［J］. 中国心血管病杂志, 2000,28(2):99-101.

［8］秦永文， 胡建强. 应用国产双盘状封堵器治疗房间隔缺损三例报告［J］. 第二军医大学学报, 2000,21(5):496-496.

［9］雷芸， 张伟华， 丁云川， 等. 国产封堵器治疗房间隔缺损疗效评价［J］. 中国介入心脏病学杂志,2003, 11(2):68-70.

备注/Memo

备注/Memo:
收稿日期：2004-12-30.
更新日期/Last Update: 2010-01-05