外科修补术与介入封堵术治疗先天性室间隔缺损效性及安全性的对比研究

摘要

目的 比较外科修补术与介入封堵术治疗先天性室间隔缺损(VSD)的有效性及安全性.方法 选取2014年2月—2016年12月第二军医大学附属长海医院心内科收治的先天性VSD患者162例,根据随机数字表法分为对照组和观察组,每组81例.对照组患者采用外科修补术,观察组患者采用介入封堵术.比较两组患者术中情况、术后恢复情况,术前和术后3个月心功能指标,并观察两组患者术后并发症发生情况.结果 对照组患者术中输血量为(461.5±59.8) ml,机械通气时间为(22.1±5.9) min,体外循环者所占比例为100％ (81/81);观察组患者术中无需输血及行机械通气、体外循环.观察组患者手术时间短于对照组(P＜0.05);两组患者手术成功率比较,差异无统计学意义(P＞0.05).观察组患者下床时间、呼吸机使用时间及住院时间短于对照组,视觉模拟评分法(VAS)评分低于对照组(P＜0.05);两组患者术前和术后3个月左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVEDD)及左心室收缩末期内径(LVESD)比较,差异均无统计学意义(P＞0.05).观察组患者并发症发生率低于对照组(P＜0.05).结论 外科修补术和介入封堵术治疗先天性VSD的成功率及对心功能的改善效果相似,但采用介入封堵术治疗患者术中损伤小、术后恢复快,且安全性较高,缺损直径为3 ～15 mm的先天性VSD患者可优先选择.%Objective To compare the effectiveness and safety in treating congenital ventricular septal defect (VSD) between surgical neoplasty and transcatheter closure.Methods From February 2014 to December 2016,a total of 162 patients with congenital VSD were selected in the Department of Cardiology,Changhai Hospital Affiliated to the Second Military Medical University,and they were divided into control group and observation group according to random number table,each of 81 cases.Patients of control group received surgical neoplasty,while patients of observation group received transcatheter closure.Intraoperative situation,recovery condition after operation,index of cardiac function before operation and after 3 months of operation were compared between the two groups,and incidence of postoperative complications was observed.Restults The intraoperative blood transfusion volume of control group was (461.5 ± 59.8) ml,duration of mechanical ventilation was (22.1 ± 5.9) min,proportion of patients undergoing mechanical ventilation was 100％;no one of observation group received blood transfusion,mechanical ventilation or extracorporeal circulation during the operation.Duration of operation of observation group was statistically significantly shorter than that of control group (P ＜ 0.05),while no statistically significant differences of success rate of operation was found between the two groups (P ＞ 0.05).Time to get out of bed,duration of breathing machine and hospital stays of observation group were statistically significantly shorter than those of control group,meanwhile VAS score of observation group was statistically significantly lower than that of control group (P ＜ 0.05).No statistically significant differences of LVEF,LVFS,LVEDD or LVESD was found between the two groups before operation or after 3 months of operation (P ＞0.05).Incidence of postoperative complications of observation group was statistically significantly lower thar that of control group (P ＜ 0.05).Conclusion Transcatheter closure has similar success rate of operation and improvement effect on cardiac function in treating congenital VSD,while the intraoperative damage of transcatheter closure is more mild,the postoperative recovery is faster,and is more safe,can be the ideal choice for congenital VSD with defect diameter between 3 mm and 15 mm.