| 婴儿动脉导管未闭合并肺部感染和心力衰竭时急诊介入封堵术 |
| 投稿时间：2014-06-07 修订日期：2014-07-03 点此下载全文 |
| 引用本文：孟祥春,谭卫群,刘麟,李博宁,徐明国,刘琮.婴儿动脉导管未闭合并肺部感染和心力衰竭时急诊介入封堵术[J].医学研究杂志,2015,44(1):116-119 |
| DOI：
10.3969/j.issn.1673-548X.2015.01.034 |
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| 中文摘要:目的 研究婴儿动脉导管未闭(PDA)合并肺部感染和心力衰竭时急诊介入治疗的可行性和安全性。方法 总结笔者医院近5年收治PDA患儿162例,其中15例婴儿合并反复的肺部感染和心力衰竭(纽约心功能分为Ⅳ级),2例合并右上肺不张,2例需呼吸机持续辅助,所有患者均经内科保守治疗后肺部感染迁延不愈,心力衰竭的症状持续存在,3例在病程中心力衰竭突然加重,其中1例术前因心力衰竭而死亡,14例患者得到了及时的干预。14例患者中男性7例,女性7例,患者年龄3~12个月,平均年龄6.7个月,体重3.5~8.0kg,平均体重5.6kg,3例合并小型室间隔膜部缺损(VSD)(2.5~4.0mm)。术前内科治疗包括持续面罩或头罩吸氧、控制心力衰竭、抗生素应用、雾化吸痰、营养支持、呼吸机辅助等。2例采用经典的PDA介入法进行封堵治疗;12例采用简化的PDA介入法治疗。应用简化的PDA介入法患者术中均需经胸超声的实时监测。术后1、3、6个月、1年回院复查心电图和超声心动图。结果 4例PDA形态为管型,9例为漏斗型,直径3~12mm,平均直径为5.4mm;均合并肺动脉高压(肺动脉压力55~110mmHg,平均压力74.5mmHg)。12例获得封堵成功;1例因输送长鞘难于从髂总静脉处送入下腔静脉,遂放弃封堵,转入外科手术结扎;1例因动脉导管粗大,呈管型,直径达12mm,选择22-24型号的封堵器,在释放后出现了封堵器移位,立即行外科取出封堵器并行PDA结扎术。术后滞留ICU时间6~12h,继续住院时间3~7天。随访中仅1例患者降主动脉血流速度增快,最高达2.15m/s,该例患者目前仍在随访中。所有患者未见血管破裂、血栓形成、动静脉瘘等血管并发症。合并小型室间隔膜部缺损3例患者,1例室缺接近闭合,左向右分流较术前明显减少;另2例室缺直径无明显变化。结论 婴儿PDA合并肺部感染和心力衰竭行急诊介入治疗安全,可行,并发症少,缩短住院时间,值得推广应用。但对于粗大管型PDA或合并有其他心内畸形时应慎重选择。 |
| 中文关键词:动脉导管未闭 急诊介入封堵 肺炎 心力衰竭 |
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| Emergency Intervention Occlusion in Infants with Patent Ductus Arteriosus Plus Pneumonia and Heart Failure |
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| Abstract:Objective To study the safety and efficacy of emergency intervention occlusion in infants with patent ductus arteriosus (PDA) associated with pneumonia and heart failure. Methods Fifteen infants with PDA plus pneumonia and heart failure were studied. There were 7 male and 7 female patients, aged 3 months to 12months old, body weight 3.5-8.0kg. Three cases also had small ventricular septal defect(VSD). Pneumonia and heart failure(HF) were diagnosed simultaneously in all the patients when intervention occlusion was implemented. Medications including inhaled oxygen, digitalis, diuretic, antibiotics, aerosolizing and airway suctioning had no effects on pneumonia and HF.Two of them had right pulmonary atelectasis. Another two cases were ventilator dependent.HF deteriorated in three cases, death occurring in one of them. Fourteen cases received percutaneous intervention occlusion. Results The PDA assumed a conical shape in 9 cases,a tubular shape in 4 cases. The median value of the narrowest PDA diameter was 5.3mm (ranging from 3 to 12mm). The mean systolic pulmonary artery were 74.5mmHg(55-110mmHg).Immediate successful occlusion of PDA was obtained in 12 cases. The long delivery sheath was introduced difficultly into inferior vena cava from iliac vein in a 5-month-old case. And surgical ligation of PDA was suggested. In another 12-month-old patient whose PDA was 12mm in size and tubular-shaped, a device of 22-24 ductal occluder was used and dropped off to the pulmonary artery soon after its separation from the cable. An immediate surgical procedure was recommended. Patients were discharged on the third to seventh day. During the following up, a peak velocity of 2.15m/s on Doppler echocardiography in one patient was observed in the descending aorta. No vascular complications including thrombosis, arterio-venous fistula, hematoma were observed. A near close was observed in one of three cases with small VSD. Conclusion Emergency intervention occlusion in infants with PDA plus pneumonia and HF is safe and effective, and thus recommended. A deep consideration should be made in case of the big tubular shaped PDA. |
| keywords:Patent ductus arteriosus Emergency intervention occlusion Pneumonia Heart failure |
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