10例法洛四联症体肺分流术后介入治疗的临床效果研究

目的:探讨对重型法洛四联症(tetralogy of Fallot,TOF)体肺分流术(Blalock-Taussig shunts;B-T)后患者通过肺动脉瓣或肺动脉球囊扩张术介入治疗增加前向肺血流,促进肺血管发育,改善双心室功能的临床效果。方法:分析自2012年7月至2013年7月,10例TOF B-T分流术后1年仍未达根治适应证的10例患者,于我科行肺动脉球囊扩张治疗的临床及随访资料,其中男性6例、女性4例,年龄4.8(1.0~13.0)岁,体质量20.3(11.0~48.0)kg,身高100.2(74.0~173.0)cm。术前经胸片、超声心动图及心血管造影、心导管等检查评估肺血管床及心室发育情况。并于术后相同时间段随访了解肺动脉和心室发育改善程度、血流动力学、心功能变化等相关参数,评价内科介入治疗在促进TOF姑息术后患者心肺发育情况,利于进一步根治的临床效果。结果:10例患者均顺利进行介入治疗。住院时间平均3.2(2.0~7.0)d。其中7例为肺动脉瓣球囊扩张术,3例行肺动脉分支球囊扩张术,SaO2:由术前平均[(80±7.0)%上升至术后(91.3士5.6)%,P0.001],跨肺动脉瓣及狭窄近、远端压差由术前[(96.3±23.3)mmHg(1mmHg=0.133kPa)下降至术后(62.2±21.2)mmHg,P0.01],右心室收缩压由术前的[(115.6±23.9)mmHg下降至(95.9±11.3)mmHg,P0.01];随访1年,病情稳定,无并发症,3例于球囊扩张后40d、7个月和1年,因肺动脉发育达根治标准而行根治手术。结论:内科介入治疗TOFB-T术后患儿能有效促进肺血管发育而利于进一步根治治疗。

Clinical effectiveness research of tetralogy of Fallot with blalock-taussig shunts intervention in 10 cases

Objective：Discusses through the pulmonary valve or pulmonary artery balloon dilatation interventional therapy to incease the patients with heavy tetralogy of Fallot＇s （TOF） prior pulmonary blood flow who have had Blalock-Taussig shunts,and promote the pulmonary vascular development,improve biventricular clinical effect function.Methods：From July 2012 to July 2013 10 cases of TOF BT shunt was yet to reach a cure patieuts in our department balloon dilatation of the pulmonary artery and clinical follow-up data,including 6 males4 females,age 4.8 （1.0-13.0） years,weight 20.3 （11.0-48.0） kg,height 100.2 （74.0-173.0） cm.Preoperative by chest X-ray,echocardiography and angiography,cardiac catheterization examination evaluate pulmonary vascular bed and ventricular development situ-ation.And in the same time period after the followup to under stand the development of the pulmonary artery and the degree of improvement in ventricular hemodynamics,cardiac function,and other related parameters,evaluate medical in-tervention in the promotion of TOF patients after cardiopulmonary development of palliative cases,help to further cure clinical.Results：10 patients were successfully interventional Security discharged from hospital.Treat-ment and safe discharge.Hospital stay3.2 （2.0 ～ 7.0） d.Seven cases of pulmonary valve balloon dilatation,3 cases of pulmonary branch balloon dila-tion,SaO2：rising from an average of [（80 ± 7.0） ％ to （91.3 ± 5.6％,P ＜ 0.001],across the pulmonary valve and narrow proximal and distal pressure from the preoperative （96.3 ± 23.3） mmHg decreased to surgery [（62.2 ± 21.2） mmHg,P ＜ 0.01],right ventricular systolic pressure decreased from （115.6 ± 23.9） mmHg preoperatively to[（95.9 ± 11.3）mmHg,P ＜ 0.01）] ;Follow-up of 1 year,in a stable condition,with no complications,there were three people in 40 days,7months and 1-year after balloon angioplasty due to the development of pulmonary better standard of radical surgery and have radical surgery