不同肺动脉压力动脉导管未闭患者介入治疗评价

摘要

Objective To evaluate the clinical value of transcatheter occlusion for patent ductus arteriosus (PDA) in patients with different pulmonary artery pressure. Methods From July 2003 to September 2010, the clinical data of 47 patients undergoing transcatheter occlusion of PDA were collected and divided into low or high groups according to the pulmonary artery pressure retrospectively. Echocardiography was performed before each procedure. The pulmonary artery pressure was determined during and after procedure and descending aortic arch radiography was performed to select proper occluder. All cases were followed up for 1 month to 7 years. Results All the PDA were successfully occluded. Pulmonary artery systolic pressure was (38. 72 ±7. 38) mm Hg in low pulmonary artery pressure group and (73. 68 ±23. 32) mm Hg in high pulmonary artery pressure group before closure; it was decreased to (29. 92 ±5. 52) mm Hg and (54. 27 ± 17. 52) mm Hg respectively after closure. The pressure was decreased more significantly in high pulmonary artery pressure group ( P < 0. 05). Two groups had a significant statistical difference in pulmonary artery systolic pressure before and after closure ( P < 0. 05 ). Low pulmonary artery pressure group had shorter total and postprocedure hospital stays. The left ventricular remodeling and cardiac function of patients in two groups were improved to some extent during follow-up, and the high pulmonary artery pressure group had a high readmission rate. Conclusions The low pulmonary artery pressure patients have mildly impaired cardiac function, shorter hospital stays, rapid recovery and low readmission rate after closure. Transcatheter occlusion for PDA should be done once it was diagnosed.%目的 探讨经导管介入封堵术治疗不同肺动脉压力动脉导管未闭(PDA)患者的临床疗效,为选择手术时机提供一定的参考依据.方法 回顾性分析接受介入封堵治疗的47例PDA患者的临床资料,按术前右心导管测得的肺动脉收缩压分为低压力组(25例)和高压力组(22例),术前行心脏彩色超声检查,术中、术后测肺动脉压力、行主动脉弓造影,出院后随访1个月至7年.结果 所有患者PDA封堵均成功.封堵前,低压力组和高压力组肺动脉收缩压分别为(38.72±7.38)mm Hg和(73.68±23.32)mm Hg;封堵后,分别下降至(29.92±5.52)mm Hg和(54.27±17.52)mm Hg,均较封堵前明显下降(均为P＜O.05),且高压力组下降更为明显.低压力组患者的总住院时间及术后住院时间较高压力组短[(5.2±1.7)d比(8.2±5.2)d,P＜0.05;(2.7±1.0)d比(4.2±2.O)d,P＜0.01].随访期间两组患者的左心室重构和心功能均有一定改善,高压力组患者再入院率较高(18.18%比0,P＜O.05).结论 低肺动脉压力患者心功能受损小,住院时间短,术后恢复快,且再入院率低,故应在发现PDA后及时行介入封堵术.