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目的探讨经胸小切口介入封堵术对成人动脉导管未闭(PDA)近期预后的影响。方法回顾性分析2008年1月至2014年1月收治的58例PDA患者的临床资料,根据不同术式分为观察组(n=30)和对照组(n=28)。观察组行经胸小切口介入封堵术治疗,对照组行体外循环手术治疗。比较两组患者围术期指标、并发症发生率及手术前后肺动脉收缩压(SPAP)、平均肺动脉压(MPAP)、左心房前后径(LAD)、左心室舒张末期内径(LVD)的变化情况。结果观察组切口长度、手术时间、呼吸机辅助时间、ICU住院时间均低于对照组(P均<0.05);术中输血率稍低于对照组,但差异无统计学意义(P>0.05)。术后两组患者SPAP、MPAP较术前均显著降低(P均<0.01)。术后1、6、12个月,两组患者LAD、LVD均低于术前(P均<0.05)。术前、术后SPAP、MPAP、LAD、LVD两组组间比较差异无统计学意义(P均>0.05);观察组与对照组术后并发症发生率差异无统计学意义(6.67%vs21.43%,P>0.05)。结论经胸小切口介入封堵术治疗PDA效果确切,有利于患者早期康复,近期预后良好。
Objective To investigate the effect of transcatheter closure of short-cut thoracic surgery on the short-term prognosis of adult patent ductus arteriosus (PDA). Methods The clinical data of 58 PDA patients admitted from January 2008 to January 2014 were retrospectively analyzed. According to the different surgical procedures, the patients were divided into observation group (n = 30) and control group (n = 28). The observation group was treated by small incision interventional closure and the control group underwent extracorporeal circulation surgery. The changes of perioperative indexes, incidence of complications and pulmonary arterial systolic pressure (SPAP), mean pulmonary arterial pressure (MPAP), left atrial appendage (LAD) and left ventricular end-diastolic diameter (LVD) before and after surgery were compared between the two groups. Results The length of incision, operative time, ventilator-assisted time and hospital stay in ICU were lower in the observation group than in the control group (all P <0.05). The blood transfusion rate in the observation group was slightly lower than that in the control group, but the difference was not statistically significant (P> 0.05) . After operation, SPAP and MPAP in both groups were significantly lower than those before operation (all P <0.01). At 1, 6, and 12 months after operation, LAD and LVD in both groups were significantly lower than those before operation (all P <0.05). There was no significant difference in the preoperative and postoperative SPAP, MPAP, LAD and LVD between the two groups (P> 0.05). There was no significant difference in the incidence of postoperative complications between the observation group and the control group (6.67% vs21. 43%, P> 0.05). Conclusions Transcatheter closure of small incision through the thoracic incision is effective in treating PDA, which is beneficial to the early rehabilitation of patients and has a good prognosis in the near future.