摘要
目的探讨介入封堵术对比外科开胸手术治疗先天性室间隔缺损患者的临床疗效。方法将2016年6月-2018年6月于衡水市人民医院心胸外科就诊的150例先天性室间隔缺损(ventricular septal defect,VSD)患者根据手术方式分为介入组和开胸组,每组各75例,观察2组治疗前后左室射血分数(LVEF)及左室舒张末期内径(LVDd)、手术一般情况、肺动脉压力变化情况、术后并发症及有效率差异。结果治疗6个月后2组LVEF、LVDd指标较前均有下降(P<0.05),但组间差异无明显统计学意义(LVEF:t=1.714,P=0.089;LVDd:t=1.969,P=0.051);介入组所需手术时间、ICU留观时间、机械通气时间、住院总时间均低于开胸组,差异具有统计学意义(P<0.05);介入组肺动脉压力正常患者治疗前后差异不明显(P>0.05),肺动脉轻度高压患者和肺动脉中度高压患者经治疗后均较前明显下降,差异具有统计学意义(P<0.05),且介入组降低肺动脉压力效果明显优于开胸组,差异具有统计学意义(轻度:t=2.814,P=0.007;中度:t=2.722,P=0.010);介入组并发症总发生率8%(6/75)明显低于开胸组20%(15/75),差异具有统计学意义(χ^2=2.110,P=0.035);介入组成功率98.7%(74/75)较开胸组97.3%(73/75)偏高,但差异无统计学意义(χ^2=0.570,P=0.556)。结论介入封堵术与外科开胸手术均可有效改善患者心功能指标,且2种治疗方式成功率无明显差异。介入较外科开胸手术可有效缩短治疗时间,降低异常肺动脉压,减少并发症发生率,具有一定的临床价值,值得应用推广。
Objective To investigate the clinical effect of interventional closure and thoracotomy in the treatment of congenital ventricular septal defect. Methods From June 2016 to June 2018, 150 patients with congenital ventricular septal defect(VSD) were divided into an intervention group and an open chest group according to the surgical method with 75 cases for each group. To observe the difference of left ventricular ejection fraction(LVEF) and left ventricular diastolic end-stage inner diameter(LVDd), general condition of operation, change of pulmonary arterial pressure, postoperative complications and effective rate in the two groups. Results After 6 months of the treatment, the levels of LVEF, LVDd in the two groups decreased significantly(P<0.05), but there was no significant difference between them(LVEF: t=1.714, P=0.089;LVDd: t=1.969, P=0.051). The operation time, ICU stay time, mechanical ventilation time and total hospitalization time in the intervention group were significantly lower than those in the open chest group(P<0.05). There was no significant difference before and after the treatment of patients with normal pulmonary arterial pressure in the interventional group(P>0.05). In the patients with mild pulmonary arterial hypertension and patients with moderate pulmonary arterial hypertension, the difference was statistically significant after the treatment(P<0.05), and the effect of reducing pulmonary arterial pressure in the intervention group was significantly better than that in the chest opening group. The difference is statistically significant(lightness: t=2.814, P=0.007;Medium: t=2.722, P=0.010);The total incidence of complications in the interventional group was 8%(6/75), which was significantly lower than that in the thoracotomy group(20%, 15/75). The difference was statistically significant(χ^2=2.110, P=0.035). The component power of interventional intervention was 98.7%(74/75), which was higher than that of open chest group(97.3%, 73/75). There was no significant difference between the two group
作者
王明杰
谢玉
WANG Mingjie;XIE Yu(Department of Rheumatism Immunology,Hengshui People′s Hospital,Hebei Hengshui 053000,China;Department of Thoracic Surgery,Hengshui People′s Hospital,Hebei Hengshui 053000,China)
出处
《新疆医科大学学报》
CAS
2019年第9期1174-1179,共6页
Journal of Xinjiang Medical University
基金
衡水市科技计划项目(G2016014095Z)
关键词
介入封堵术
开胸手术
先天性室间隔缺
并发症
interventional closure
thoracotomy
congenital ventricular septal defect
complication
