完全超声引导与放射线引导行经皮肺动脉瓣球囊成形术的对比研究

摘要

目的:通过与传统放射线引导方法相比较,评价完全超声引导下经皮肺动脉瓣球囊成形术(PBPV)的安全性和有效性.方法:收集我院2013-03至2016-08完全超声引导下行PBPV患者102例(超声组),同期传统放射线引导下行PBPV患者280例(放射线组).两组患者术后均以超声心动图进行随访和评价治疗效果.结果:两组患者年龄、体重、肺动脉瓣环直径、术前肺动脉瓣跨瓣压差、球囊直径、术后即刻跨瓣压差、住院时间及住院费用差异均无统计学意义(P均＞0.05).超声组和放射线组手术成功率分别为99.0％和100％ (P=0.267),超声组有1例患者因扩张后右心室流出道肌肉痉挛转为常规外科手术.放射线组术中操作时间(min)长于超声组(38.9±9.2比34.6±10.0,P＜0.001),放射线组放射线时间为(3.9±1.2) min.术后门诊平均随访(25.5±13.2)个月,超声组和放射线组肺动脉瓣跨瓣压差(mmHg,1 mmHg=0.133 kPa)分别为(16.2±4.3比15.3±4.5,P=0.120),两组患者均无死亡、外周血管损伤、心脏穿孔、心包积液等严重并发症.结论:完全超声引导下PBPV不仅能够完全避免放射线及对比剂,而且保持了传统经皮介入治疗微创、安全及疗效确切的优点.%Objective:To evaluate the safety and efficacy of ultrasound guidance for percutaneous balloon pulmonary valvuloplasty (PBPV) in comparison with conventional X-ray guidance.Methods:Our research included in 2 groups:Ultrasound group,n=102 patients with PBPV under ultrasound guidance in our hospital from 2013-03 to 2016-08 and X-ray group,n=280 patients with PBPV under traditional X-ray guidance in our hospital at the same period of time.Post-operative effect was evaluated by echocardiography and compared between 2 groups.Results:The patients' age,body weight,pulmonary artery diameter,immediate post-operative pulmonary transvalvular pressure gradient (PTPG),the in-hospital time and cost were similar between 2 groups,P＞0.05.The success rate of operation in Ultrasound group and X-ray group was 99.0％ vs 100％,P=0.267.In the ultrasound group,1 patient was converted to a conventional surgery due to right ventricular outflow tract muscle spasm after dilation.The operation time in X-ray group was longer than Ultrasound group,(38.9±9.2) min vs (34.6±10.0) min,P＜0.001.The X-ray exposure time was (3.9±1.2) min in X-ray group.The mean follow-up time was (25.5±13.2) months and PTPG in Ultrasound group and X-ray group were (16.2±4.3) mmHg and (15.3±4.5) mmHg,P=0.120.No serious complications as death,peripheral vascular injury,cardiac perforation and pericardial effusion occurred in either group.Conclusion:PBPV under complete ultrasound guidance may not only avoid radiation and contrast agent,but also keep the safety and efficacy of minimally invasive conventional percutaneous interventional treatment.