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目的与经皮主动脉瓣球囊成形术进行比较,评价经胸主动脉瓣球囊成形术治疗主动脉瓣狭窄的优势和缺点。方法建立3个月龄小猪主动脉瓣狭窄模型,其主动脉瓣压差均>30mm Hg;20头模型猪随机分为经胸组与经皮组各10头,分别行经胸及经皮主动脉瓣球囊成形术,比较2组主动脉瓣压差下降值、放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率及主动脉后壁损伤率。结果经胸组术前、术后主动脉瓣压差((42.6±2.9)、(14.4±2.6)mm Hg)与经皮组((43.9±3.6)、(15.7±3.1)mm Hg)比较差异均无统计学意义(P>0.05),2组术后主动脉瓣压差均较术前明显降低,差异均有统计学意义(P<0.01);经胸组放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率((6.8±2.5)min、0、0、0)低于经皮组((11.9±4.2)min、40%、40%、100%)(P<0.05),经升主动脉置入传统动脉鞘管后主动脉后壁损伤率(80%)明显高于经皮组(0)(P<0.01)。结论经胸主动脉瓣球囊成形术在放射线暴露时间、病死率、外周血管损伤发生率、起搏器使用率等方面具有优势,但主动脉后壁损伤发生率高。
Objective To evaluate the advantages and disadvantages of trans-thoracic aortic balloon angioplasty in the treatment of aortic stenosis by comparing with percutaneous aortic balloon angioplasty. Methods Aortic stenosis model of 3-month-old piglets was established. The aortic valve pressure difference was> 30mm Hg. Twenty pigs were randomly divided into transthoracic group and percutaneous group, Arterial balloon angioplasty was performed to compare the descending aortic valve pressure drop, radiation exposure time, mortality, incidence of peripheral vascular injury, pacemaker utilization and aortic posterior wall injury rate. Results Compared with the percutaneous group (43.9 ± 3.6) and (15.7 ± 3.1) mm Hg), the difference of the aortic valve pressure before and after the thoracotomy was (42.6 ± 2.9) and (14.4 ± 2.6) mm Hg respectively (P> 0.05). The pressure difference of aortic valve in two groups after operation was significantly lower than that before operation (P <0.01). The radiation exposure time, mortality, peripheral The incidence of vascular injury and pacemaker utilization were significantly lower than those in the percutaneous group ((6.8 ± 2.5) min, 0,0,0) (P <0.05 for the group of (11.9 ± 4.2) min, 40%, 40%, 100% ). The posterior aortic wall injury rate (80%) after the ascending aorta was inserted into the traditional arterial sheath was significantly higher than that of the percutaneous group (0) (P <0.01). Conclusions Trans-thoracic aortic balloon angioplasty has advantages in terms of radiation exposure time, mortality, incidence of peripheral vascular injury and pacemaker utilization, but the incidence of aortic posterior wall injury is high.