国产封堵器置入治疗先天性心脏病16例

回顾性分析2007-10/2008-11天长市人民医院心内科收治的先天性心脏病患者16例，经超声心动图检查确诊动脉导管未闭4例，房间隔缺损6例，室间隔缺损6例；男4例，女12例；年龄5~52岁。动脉导管未闭直径5~17 mm；房间隔缺损直径20~32 mm；室间隔缺损直径4~10 mm。全部患者均接受国产Amplatzer封堵器置入治疗，置入过程中超声心动图及造影检测动脉导管未闭、房间隔缺损和室间隔缺损直径，置入后72 h心脏超声心动图检查观察疗效。全部患者均一次置入封堵器，置入成功率100%，置入过程中未发生重要并发症。置入后72 h超声心动图检查无残余分流出现。4例患者置入后发热，其中2例为急性上呼吸道感染；2例静脉复合麻醉手术患者置入后合并肺部感染。2例患儿置入后在苏醒过程中谵妄烦躁，而出现局部血肿，硫酸镁湿敷后消退。1例房间隔缺损和2例室间隔缺损置入后出现心律失常。提示只要严格按照适应证选择患者，应用国产封堵器置入治疗动脉导管未闭、房间隔缺损、室间隔缺损是安全有效的。     

小儿先天性心脏病的治疗进展：国产封堵器的应用及评价

小儿先天性心脏病主要包括房间隔缺损、动脉导管未闭和室间隔缺损,均可行封堵器置入治疗。经导管置入封堵器治疗先天性心脏缺损已成为先天性心脏病的主要治疗手段。近年来,国产封堵器治疗小儿先天性心脏病在国内广泛普及。但应用封堵器置入治疗时还要严格掌握适应证和置入操作要领,尽量减少其并发症。文章检索并归纳了相关国内文献,介绍了近年来先天性心脏病的治疗进展,阐述了不同类型封堵器在房间隔缺损、动脉导管未闭和室间隔缺损的临床应用,并评价其生物相容性。     

国产封堵器封堵先天性膜部室间隔缺损：安全性及血流动力学指标变化

目的：观察国产封堵器封堵先天性膜部室间隔缺损的安全性，及封堵前后左心功能和血流动力学指标的变化。 方法：①对象：选择2003-08/2006-03安徽医科大学第一附属医院心内科应用国产封堵器治疗先天性膜部室间隔缺损患者82例。男43例，女39例；平均年龄（14.3±10.7）岁。其中26例为膜部瘤，1例合并房间隔缺损。②方法：术中经左心室造影确定室间隔缺损的位置、大小及形态，造影后经股动脉送入Judkin右冠状动脉造影导管至左心室，调整导管通过缺损处进入右心室，送入面条导丝至肺动脉或上腔静脉，经股静脉送入圈套器达肺动脉或上腔静脉，套住导丝拉出体外，建立股动脉至股静脉轨道。沿轨道钢丝经股静脉侧送入6-9F输送鞘管至左心室，透视和经胸超声心动图监视下释放封堵器，在左心室释放左心室面伞，轻轻回撤整个输送系统，当左心室面伞紧贴室间隔时，释放右心室面伞，经胸超声心动图和左心室造影证实封堵器位置良好，无心室水平左向右分流，主动脉瓣和三尖瓣功能未受影响，表明封堵成功。③评估：封堵前、封堵后3 d、1个月、1年行经胸超声心动图检查，观察左房内径、左室舒张末期内径、左室收缩末期内径、射血分数、每搏输出量、左室短轴缩短率的大小及变化。 结果：78例成功置入封堵器，治疗成功率95%。左心室造影测量缺损直径为2~12 (5.1±2.4) mm ，封堵器直径4~14 (6.7±2.9) mm 。经胸超声心动图随访过程中所有封堵器位置及形态良好, 封堵后行左心室造影，1例有少许残余分流,1个月后残余分流消失。封堵后3 d、1个月及1年左房内径、左室舒张末期内径、左室收缩末期内径、每搏输出量较封堵前明显缩小﹙P < 0.01﹚，而封堵后3 d、1个月射血分数、左室短轴缩短率无明显变化，封堵后1年射血分数、左室短轴缩短率较封堵前显著下降﹙P < 0.05﹚, 且上诉6项指标均恢复正常。 结论：国产封堵器应用于先天性膜部室间隔缺损未发现特殊生物相容性问题，能够有效的改善室间隔缺损患者的左心功能。     

封堵器材料特征及与宿主的生物相容性

目的：评价不同种封堵器材料的性能以及置入体内与宿主的生物相容性,为其在临床上的应用提供参考依据。 方法：以“封堵器,封堵器材料,组织相容性,血液相容性,先天性心脏病”为中文关键词;以“blocking material,blocking material material,histocompatibility,blood compatibility,congenital heart disease” 为英文关键词,采用计算机检索2006-01/2010-03相关文章。纳入与有关生物材料与宿主相容性的文章;排除重复研究或Meta分析类文章。以30篇文献为重点进行探讨封堵器材料的种类、性能及应用前景。 结果：心脏封堵器的类型较多,而已国产Ampeatzer封堵器应用广泛,材料多为镍钛合金类,其宿主生物相容性较好,封堵效果也较好,因费用较低,临床广泛应用。 结论：金属材料制备的封堵器虽应用广泛,但不可避免存在着腐蚀现象,从而相容不良,可能会引发附近组织发炎,产生病变,造成溶血或凝血现象等。理想的封堵器材料无论材料本身还是其降解产物都不能产生炎症和毒性反应,所以良好生物相容性的封堵器需进一步开发研制。 关键词：封堵器;封堵器材料;组织相容性;血液相容性;先天性心脏病 doi:10.3969/j.issn.1673-8225.2010.29.036     

小儿先天性心脏病术后神经系统并发症的护理

本文对我院2010-01—2011-01收治的30例小儿先天性心脏病术后神经系统并发症患者的临床护理方法进行回顾性分析,具体分析如下。1资料与方法1.1临床资料选取我院2010-01—2011-01收治30例小儿先天性心脏病术后神经系统并发症患者,男15例,女15例;年龄2～14岁,平均(7.1±1.2)岁。其中并发缺血缺氧性脑病20例,轻度脑损害10例。患者主要表现为嗜睡和神志恍惚以及易激惹与烦躁不安、抽搐等症状。     

髌骨骨折镍钛合金丝内固定的生物力学特点*★

背景：目前临床广泛使用不锈钢丝进行髌骨骨折内固定。根据镍钛合金的超弹性材料特性，设想改用镍钛合金丝进行固定，从生物力学角度，预期可获得更佳疗效。　 目的：评价镍钛合金丝环形加“8”字固定髌骨骨折的生物力学稳定性，并与不锈钢丝进行比较。 设计、时间及地点：生物力学分析，于2002-07/2003-03在福建省骨伤研究所生物力学实验室完成。 材料：新鲜、无病变、保留股四头肌肌腱和髌韧带的髌骨，为7名因车祸及其他外伤而截肢的成年男性患者自愿捐献。 方法：股四头肌拉力以50，100，150，200，250，300 N加载和卸载两种方式作用于受试髌骨，应用电测法测量不完全横形髌骨骨折未经金属丝固定、钢丝环形加“8”字内固定及镍钛合金丝环形加“8”字内固定后的髌骨前面应力。 主要观察指标：镍钛合金丝内固定和不锈钢丝内固定对髌骨断面的加压作用。 结果：股四头肌拉力从150 N增加到300 N时，不锈钢丝固定对髌骨骨折断面的加压作用由0.289 4 MPa剧增至0.454 4 MPa，增加57.01%；同样情况下，镍钛合金丝固定对髌骨骨折断面的加压作用则仅由0.227 0 MPa缓增至0.285 1 MPa，增加25.59%。当股四头肌拉力从300 N降至150 N时，不锈钢丝固定对髌骨骨折断面的加压作用由0.436 5 MPa骤减至0.244 8 MPa，减少43.91%；而镍钛合金丝固定对髌骨骨折断面的加压作用则仅由0.231 6 MPa减至0.173 7 MPa，减少25.00%。 结论：与不锈钢丝固定相比，镍钛合金丝固定能对髌骨骨折断面提供持续的、小幅变化的加压作用。     

高压氧治疗脑部疾病合并先天性心脏病患儿的护理

近年来,脑部疾病合并先天性心脏病的患儿逐渐增多,病情危重,若未进行正确处理,预后不佳,可留有不同程度的后遗症,严重影响患儿的生存质量及家庭的幸福度[1]。目前,高压氧作为一门新型、独立的学科深入临床治疗中,为人类疾病的治疗拓展了更大的空间。利用高压力环境,可明显提高机体组织氧含量,快速缓解患儿缺氧症状[2]。本文选取80例脑部疾病合并先天性心脏病患儿为研究对象,探讨高压     

封堵器置入部位与室间隔缺损治疗后的心律失常☆

目的：心律失常是封堵器置入治疗膜周部室间隔缺损严重并发症之一，目前尚无明确有效的预防方法。分析封堵器置入膜部瘤体内能否预防严重心律失常的发生。 方法：选择2002-01/2007-06河北医科大学第一医院共完成治疗室间隔缺损患儿1 810例，其中采用封堵器置入治疗644例，以封堵器左盘面是否跨越左心室基底部为界分为置入膜部瘤体与置入左心室基底部两种。外科手术治疗1 166例。术后严格综合监护1周，出院前复查心电图和超声心动图，出院后1，3，6，12，24个月作定期随访超声心动图、心电图。 结果：①封堵器置入组的三度房室传导阻滞和完全性左束支传导阻滞的发生率高于外科手术组(P < 0.05)，而二度Ⅱ型房室传导阻滞的发生率低于外科手术组(P < 0.05)。②对于伴膜部瘤形成者，封堵器置入组的三度房室传导阻滞和完全性左束支传导阻滞的发生率高于外科手术组(P < 0.05)；而如果将封堵器置入膜部瘤体内，发生三度房室传导阻滞、二度Ⅱ型房室传导阻滞及完全性左束支传导阻滞均明显低于置入基底部者(P < 0.05)，也明显低于不伴膜部瘤形成而置入基底部组及外科手术组（包括伴膜部瘤形成和不伴膜部瘤形成）(P < 0.05)。③对于外科手术组，伴膜部瘤形成和不伴膜部瘤形成者术后严重心律失常的发生率无统计学意义(P > 0.05)。④材料与组织的生物相容性：封堵器置入体内后血小板黏附较少，凝血功能检查、免疫系统反应（免疫球蛋白、补体）、 材料表面再内皮化反应均正常，未发生炎症等宿主反应。无封堵器脱落等材料反应发生。 结论：①封堵器置入膜部瘤体可有效降低膜部瘤型室间隔缺损治疗后严重心律失常的发生。②封堵左室基底部时应特别注意避免封堵器过大变形。     

镍钛合金支架-脑膜建复合体重建额窦修补脑脊液鼻漏的实验研究

目的 探讨一种新型颅底重建材料-镍钛合金支架-脑膜建复合体在动物实验中的疗效和实用性. 方法 以7只健康成年家犬为实验动物,构建额窦缺损-脑脊液鼻漏模型(拟单纯建模2只,实验治疗5只).制作镍钛合金支架-脑膜建复合体及其相应简易器械,对动物模型进行重建额窦修补脑脊液鼻漏操作.术后观察颅骨外形、切口愈合及脑脊液漏情况.术后3月行X片、CT三维重建、MRI及组织病理学检查. 结果 成功构建了健康成年家犬额窦缺损-脑脊液鼻漏模型7只,其中单纯建模、未实施实验治疗的1只于术后5d死亡,成功实施重建额窦修补脑脊液鼻漏手术6只(包括1只补充实验治疗的单纯建模动物),均全部存活,切口愈合良好,无脑脊液漏,无组织膨出及神经功能缺失等并发症;影像学检查显示支架显影清晰,位置满意,无伪迹;组织病理学显示支架周围肉芽组织生长. 结论 镍钛合金支架-脑膜建复合体应用于家犬重建额窦修补脑脊液漏手术时使用方便、效果良好.     

复杂型先天性心脏病术后神经系统并发症的护理

目的 总结复杂型先天性心脏病术后神经系统并发症的护理方法和经验.方法 纳入8例复杂型先天性心脏病术后神经系统并发症患者的临床资料,回顾性总结护理方法和护理要点.结果 8例患儿中2例因多脏器衰竭而死亡,1例因低心排综合征而死亡,其他患儿给予对症治疗及有效的护理措施均顺利出院.结论 术后神经系统并发症是复杂型先天性心脏病患...     

国产封堵器封堵治疗先天性心脏病106例

2004-10/2008-11赣州市立医院心内科使用国产封堵器介入治疗先天性心脏病患者106例,均经临床、心电图及经胸超声心动图检查确诊并有行介入封堵治疗的适应证。患者均经股静脉穿刺行右心导管检查及送入封堵器械,动脉导管未闭和室间隔缺损需经股动脉穿刺,封堵前行主动脉弓降部或左室造影以进一步明确诊断和适应证,帮助选择封堵器的型号,术后重复造影以判断封堵效果;房间隔缺损和室间隔缺损患者术中常规行经胸超声心动图监测和评价。所有患者均使用国产封堵器及其配套输送系统。封堵后随访1个月~4年,手术成功率99.1%(105/106),无心脏瓣膜受损、封堵器脱落移位,释放封堵器后残余分流约4.7%(5/106),Ⅲ度房室传导阻滞0.9%(1/106),发生溶血0.9%(1/106)。随防中未发现血栓形成、组织排异反应、细胞毒性及急性全身中毒现象。结果提示严格把握适应证,国产封堵器介入治疗先天性心脏病具有简便易行、安全可靠、技术成功率高等优点,且比进口封堵器价格更低廉,规格更齐全。     

Auditory brainstem responses in congenital heart disease

To evaluate the effect of chronic hypoxemia on brainstem maturation, auditory brainstem responses were examined in 70 children (32 with and 38 without cyanosis) who had congenital heart disease. Ninety-one age-matched normal children served as controls. At 1–3 months of age, the I–V interpeak latencies of cyanotic infants (mean ± S.D.; 5.17 ± 0.17 ms) were more prolonged than were those of controls (4.95 ± 0.11 ms) and those without cyanosis (4.84 ± 0.22 ms; P < .05; P < .01). At 4–11 months of age, the I–V interpeak latencies of cyanotic infants (4.85 ± 0.13 ms) were more prolonged than were those of controls (4.67 ± 0.19 ms) and those not experiencing cyanosis (4.5 ± 0.17 ms; P < .05; P < .01). In the cyanotic children, there was a significant negative correlation between the I–V interpeak latency and oxygen partial pressure (P < .01) or oxygen saturation (P < .05). Three of the 70 patients (4.3%) with congenital heart disease had absent auditory brainstem response. These data indicate that chronic hypoxemia may be one of the factors in retarded brainstem maturation.     

Electroencephalographic abnormalities in children with congenital heart disease

Ninety-eight consecutive patients with clinically suspected congenital heart disease were prospectively studied with electroencephalographic (EEG) recordings before cardiac catheterization. Twenty-five patients had abnormal EEGs. Fifty-five patients had acyanotic heart disease and normal neurologic examination results, of whom 15 had abnormal EEGs. Thirteen had spikes or spike and wave discharges and two had mildly abnormal EEGs. Twenty-seven patients had cyanotic heart disease and normal neurologic examination results, of whom four had abnormal EEGs. Seven patients (8%) had abnormal neurologic examination results, of whom four had abnormal EEGs. There was a higher incidence of seizures with increasing age. Based on their medical history two children with acyanotic heart disease had had seizures without EEG abnormalities. Five children with normal catheterization findings and four children with Down's syndrome (two with abnormal EEGs) were excluded from the total of 98. These findings suggest that subclinical nervous system involvement may occur in congenital heart disease.     

Chylothorax in children with congenital heart disease: Incidence of thrombosis

Postoperative chylothorax is a frequently encountered pathology occurring in up to 4% of patients undergoing surgery for repair of congenital heart disease. Symptomatic thrombosis is associated with chylothorax and may contribute to its severity and duration. Furthermore, vessel thrombosis resulting in persistent vessel occlusion may impede future treatments, diagnostic studies and cardio-surgical interventions. The objective of this study was to determine the incidence of upper system thrombosis in pediatric congenital heart patients with confirmed chylothorax with ultrasound screening of all patients diagnosed with chylothorax. All pediatric patients with confirmed with chylothorax underwent doppler ultrasound of the upper venous system as per hospital standard. This retrospective cohort study enrolled all children between February 1, 2010-August 2012, post cardiac surgery with confirmed chylothorax to determine the incidence of all thrombosis. There were 1396 children who underwent 1396 cardiac surgical procedures during the study time with 760 undergoing cardiopulmonary bypass. Development of chylothorax occurred in 54 of 1396, 3.9% (95%CI 3.0;5.0) procedures in all children. In those children with chylothorax, 28 of 54 episodes, 51.8% (95%CI 38.9;64.6) had confirmed VTE. The 51.8% incidence in this study demonstrates a 2.6 fold increase in risk of thrombosis compared to 20% in children with heart disease and central venous lines and may result in serious clinical consequences. The contribution of upper venous system thrombosis to chylothorax is unknown. Often, clinical suspicion of chylothorax exists, however the lack of a standardized approach to objective diagnosis results in delayed confirmation. Approaches to therapy either treatment of confirmed thrombosis or prevention of thrombosis in patients with chylothorax require formal evaluation. Future studies are urgently needed.     

A cross-sectional study of the prevalence of psychopathology in adults with congenital heart disease

OBJECTIVE: Several studies have suggested high levels of psychopathology in children and adolescents with congenital heart disease (CHD). However, little information is published relating to psychopathology in adults with CHD. We wanted to estimate the prevalence of psychopathology in adults with CHD. DESIGN: A cross-sectional study of attenders at an adult CHD clinic compared with orthopaedic outpatients of the same hospital. SETTING: A tertiary CHD clinic in South Wales, the comparison group being recruited from the orthopaedic outpatient clinic in the same teaching hospital. PARTICIPANTS: One hundred and one individuals attending the CHD clinic were identified, 87 successfully completed questionnaires. Forty-five from 80 randomly selected orthopaedic outpatients completed questionnaires. MAIN OUTCOME MEASURES: The General Health Questionnaire 30 (GHQ30) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: We found a statistically significant difference in the mean GHQ 30 score between the CHD and comparison groups, the CHD group having lower scores. The difference remained after adjustment for age and sex. The mean HADS scores differed in the same direction, and were of borderline statistical significance. CONCLUSIONS: In this study, adult subjects with CHD had a lower prevalence of psychopathology. Possible explanations for this finding are discussed.