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目的探讨经胸超声指导下小儿动脉导管未闭(PDA)封堵术的临床应用价值。方法选取我院2011年4月至2012年4月小儿PDA的患者123例,100例动静脉法组为对照组,肾功能异常的及碘对比剂过敏的患者共23例单静脉法为试验组,采用经导管介入封堵术治疗,术后3d、1个月、3个月、6个月行经胸超声心动图随访,观察两组的封堵成功率、并发症和远期疗效。结果两组技术成功率100%,试验组未使用碘对比剂,手术总时间为(25.0±7.3)min,透视时间为(4.3±1.4)min,X线辐射剂量为(45.0±5.4)mGy,血管并发症发生1例,发生率为4.34%;对照组使用碘对比剂为(19.7±3.4)ml,手术总时间为(35.0±8.6)min,透视时间为(7.5±1.5)min,X线辐射剂量为(73.0±6.2)mGy,血管并发症发生10例,发生率为10.0%,试验组与对照组比较差异有统计学意义(P<0.05);术后3d、1个月、3个月、6个月经胸超声心动图随访均无残余分流,封堵器位置好,肺动脉压力正常,试验组与对照组比较差异无统计学意义(P>0.05)。结论经胸超声指导下小儿PDA封堵法是一种安全可行的方法。在碘对比剂的用量、手术总时间、透视时间、X线辐射剂量及血管并发症方面,无造影单静脉法均优于造影的动静脉法。
Objective To investigate the clinical value of transcatheter closure of pediatric patent ductus arteriosus (PDA) guided by transthoracic ultrasound. Methods A total of 123 patients with PDA in our hospital from April 2011 to April 2012 were enrolled in this study. One hundred patients with arteriovenous malnutrition group as control group, 23 patients with renal dysfunction and allergic iodine contrast agent as experimental group The patients were followed up by transthoracic echocardiography after 3d, 1 month, 3 months and 6 months after operation. The success rate, complications and long-term curative effect of the two groups were observed. Results The technical success rate was 100% in both groups. The iodine contrast agent was not used in the two groups. The total operation time was (25.0 ± 7.3) min, the fluoroscopy time was (4.3 ± 1.4) min, the radiotherapy dose was (45.0 ± 5.4) One case of vascular complications occurred, the incidence was 4.34%. The control group was (19.7 ± 3.4) ml iodine contrast agent, the total operation time was (35.0 ± 8.6) min, the fluoroscopy time was (7.5 ± 1.5) min, The radiation dose was (73.0 ± 6.2) mGy, vascular complications occurred in 10 cases, the incidence rate was 10.0%, the difference between the experimental group and the control group was statistically significant (P <0.05); 3d, 1 month, 3 The follow-up of transthoracic echocardiography in month and 6 months showed no residual shunt, occluder location was good and pulmonary artery pressure was normal. There was no significant difference between the experimental group and the control group (P> 0.05). Conclusion Transcatheter ultrasound guided PDA occlusion method is a safe and feasible method. In the iodine contrast agent dosage, the total operation time, fluoroscopy time, X-ray dose and vascular complications, non-contrast single vein method are superior to angiography arteriovenous method.