2018 年第 6 期 第 13 卷

西藏地区动脉导管未闭患儿的临床特点及介入封堵疗效分析

Clinical characteristics and efficacy of interventional therapy in Tibetan children with patent ductus arteriosus

作者：顾燕王霄芳郭保静梁永梅肖燕燕王志远吕震宇金梅

英文作者：

单位：100029首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所

英文单位：

关键词：动脉导管未闭;介入封堵治疗;肺动脉高压

英文关键词：

• 摘要：

• 【摘要】目的    探讨西藏地区动脉导管未闭(PDA)患儿的临床特点及介入封堵治疗的效果。方法    选择2015年1月至2016年12月于首都医科大学附属北京安贞医院住院治疗的来自西藏自治区的PDA患儿99例，平均年龄（127±48）个月，平均身高（130±18）cm，平均体质量（27±11）kg。68例患儿（68.7%）合并不同程度的肺动脉高压。经胸部X线片、超声心动图及造影检查，按照动脉导管的形态及内径分组，分析不同动脉导管内径分组患儿封堵术前后的超声心动图检测结果。结果    99例患儿主动脉弓降部造影Krichenko分型：漏斗型56例（56.6%），怪异型19例（19.2%），长管型15例（15.2%），短管型6例（6.1%），狭窄型3例（3.0%）。按PDA最窄处内径分组，<2 mm 2例（a组），2~4 mm 34例（b组），＞4~<6 mm 18例（c组），6~<10 mm 36例（d组），≥10 mm 9例（e组）。右心导管检查示肺循环血流量/体循环血流量均大于1.5；其中9例合并重度肺动脉高压患儿行右心导管检查明确为动力性肺动脉高压，行试封堵试验后永久封堵。所有患儿封堵成功，无并发症。除a组外，封堵后2 d各组左心室舒张末期内径、肺动脉压均明显低于封堵前（均P<0.05）。各组封堵前的左心室射血分数均在正常范围，除a组外，各组封堵后2 d 左心室射血分数均明显低于封堵前（均P<0.05）。结论    西藏地区PDA患儿合并肺动脉高压的比例高，动脉导管类型中长管型及怪异型占相当比例，大直径动脉导管多，经综合评估，选择合适的封堵器介入封堵成功率高。

• 【Abstract】Objective    To analyze the clinical characteristics and efficacy of interventional therapy in Tibetan children with patent ductus arteriosus(PDA). Methods    Ninety-nine Tibetan children with PDA who had transcatheter closure in Beijing Anzhen Hospital, Capital Medical University from January 2015 and December 2016 were enrolled; the mean age was（127±48） months; the mean height was （130±18）cm; the mean weight was （27±11）kg; 68 children（68.7%） had pulmonary artery hypertension. All patients were diagnosed by X-ray, echocardiography and angiography; PDA type and diameter of arterial duct were observed; the effect of PDA closure was observed by echocardiography and angiography 2 d after operation. Results    Krichenko classification of aortic arch showed 56 cases of funnel type （56.6%）, 19 cases of weird type （19.2%）, 15 cases of long type （15.2%）, 6 cases of short type （6.1%） and 3 cases of stenotic type （3.0%）. According to the minimum diameter of PDA, the children were divided into group A（<2 mm）, group B（2-4 mm）, group C（＞4-<6 mm）, group D（6-<10 mm） and group E（≥10 mm）. Right heart catheterization showed the ratio of pulmonary flow to systemic blood flow＞1.5 in all children. Nine children with severe pulmonary artery hypertension had successful permanent transcatheter closure. No postoperative complication was observed. Left ventricular end-diastolic dimension, pulmonary arterial pressure and left ventricular ejection fraction 2 d after operation were significantly lower than those before operation in group B, C, D, E（P<0.05）. Conclusions    Incidence of pulmonary artery hypertension is high in Tibetan children with PDA; long type, weird type and large diameter of PDA are common. Transcatheter closure has a good curative effect on PDA in Tibetan children.