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目的探讨椭圆周长公式在儿童房间隔缺损(ASD)介入治疗中的应用,评价Amplatzer封堵器对长程随访中心脏几何形态学和心功能变化的影响。方法选取ASD患儿120例,随机分为A、B2组,每组各60例,2组年龄及性别比较无显著性差异。A组引用椭圆周长公式计算缺损直径,以此选用Amplatzer封堵器型号;B组按超声测量直径选择封堵器。应用经胸超声心动图(TTE)分别测量ASD患儿经导管ASD封堵治疗术前、术后3个月、术后6个月及术后1a的左房收缩末期横径(LALD)、右房收缩末期横径(RALD)、RALD/LALD、右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)、RVDD/LVDD比率、肺动脉内径(PD)及左右心室射血分数。结果A组缺损内径为(18.95±4.13)mm,B组为(19.12±5.38)mm,其差异无统计学意义(P>0.05)。A组封堵器直径为(20.98±5.59)mm,B组为(23.67±6.36)mm,其差异有统计学意义(P<0.05)。119例封堵术成功,A组1例失败,成功率98.3%,无任何手术相关并发症发生。二组ASD封堵术后随访1a,RALD、RVDD、RALD/LALD和RVDD/LVDD显著下降,PD逐渐缩小,LVAD、LVDD于术后逐渐增大,左、右室射血分数均明显改善(Pa<0.05),与术前比较有显著性差异(Pa<0.05,0.01);A组心脏重构逆转及心功能改善程度明显大于B组(Pa<0.05)。结论椭圆周长公式在患儿ASD封堵器选择中具有应用价值,Amplatzer封堵器大小对患儿心脏重构及心功能的改善有影响。
Objective To investigate the application of the ellipse perimeter formula in the interventional treatment of children with atrial septal defect (ASD) and to evaluate the influence of Amplatzer occluder on cardiac geometric changes and cardiac function during long-term follow-up. Methods A total of 120 children with ASD were selected and randomly divided into A and B2 groups, 60 cases in each group. There was no significant difference between the two groups in age and sex. Group A reference ellipse circumference formula to calculate the diameter of the defect, so choose Amplatzer occluder model; B group chooses the occluder according to the ultrasonic measurement diameter. The transthoracic echocardiography (TTE) was used to measure the left atrial systolic diameter (LALD), the right atrial appendage RALD, RALD / LALD, RVDD, LVDD, RVDD / LVDD, pulmonary artery diameter (PD) and left ventricular ejection fraction were measured. Results The average diameter of defect in group A was (18.95 ± 4.13) mm, while in group B was (19.12 ± 5.38) mm, the difference was not statistically significant (P> 0.05). The diameter of occluder in group A was (20.98 ± 5.59) mm, while in group B was (23.67 ± 6.36) mm, the difference was statistically significant (P <0.05). One hundred and ninety-nine cases were successfully blocked. One patient in group A failed with a success rate of 98.3% without any operative complications. In the two groups, the RDA, RVDD, RALD / LALD and RVDD / LVDD decreased significantly, the PD gradually decreased, the levels of LVAD and LVDD gradually increased and the left and right ventricular ejection fraction (P <0.05, 0.01). The reversal of cardiac remodeling and the improvement of cardiac function in group A were significantly greater than those in group B (P <0.05). Conclusion The formula of ellipse circumference has an application value in the selection of ASD occluder in children. Amplatzer occluder size has an impact on cardiac remodeling and cardiac function in children.