论文部分内容阅读
目的:探讨二维超声心动图(2DE)及彩色多普勒血流显像(CDFI)实时动态监测动脉导管未闭(PDA)导管法封堵治疗过程中残余分流变化规律及临床意义。方法:选择2002年1月至2006年6月102例应用Amplatz-er封堵器进行封堵治疗并有术中超声心动图监测的连续性PDA患者为观察对象,年龄1~63,平均(9.2±8.2)岁,术前2DE和CDFI测量PDA的最小内径为2.0~14.2,平均(6.1±1.9)mm,长度为2.1~15.8,平均(10.0±2.5)mm。当封堵器到位后,应用2DE及CDFI对残余分流进行实时动态监测,记录即刻、5、10、15、20、25、30min共7个阶段的各项观察指标,包括残余分流类型、比例及分流束宽度的变化。结果:(1)封堵器定位后即刻,102例患者中19例(18.6%)无任何类型残余分流、83例(81.4%)患者仍有残余分流;在有残余分流的患者中,CDFI共检出中央型残余分流束41个、边缘型残余分流束133个(宽度<2mm者102个、宽度≥2mm者31个);(2)CDFI动态监测过程中,所有中央型残余分流束均在15min内、多数10min内可自行迅速消失;95%宽度<2mm的边缘性残余分流束25min时可自行消失,30min时5个尚未消失的残余分流束宽度均<1mm;而宽度≥2mm的边缘残余分流6%在30min时可自行消失,余94%不能自行消失,且其宽度在各阶段无显著变化;宽度<2mm和≥2mm的边缘性残余分流束在30min时尚存的残余分流分别为5%和94%(P<0.001)。结论:超声心动图动态监测PDA导管封堵治疗后残余分流变化简单可行,可替代X线造影;边缘性残余分流宽度≥2mm、持续时间30min而无明显变化者,应予更换封堵器,以免造成长期残余分流。
OBJECTIVE: To investigate the regularity and clinical significance of residual shunt in the course of occlusion of PDA with catheterization of two-dimensional echocardiography (2DE) and color Doppler flow imaging (CDFI) in real time. Methods: A total of 102 consecutive PDA patients undergoing amputation with Amplatz-er occluder and having intraoperative echocardiographic monitoring from January 2002 to June 2006 were enrolled in this study. Patients (range, 1 to 63, mean ± 8.2) years old. The minimum internal diameter of PDA measured by 2DE and CDFI preoperatively was 2.0 ~ 14.2, with an average of 6.1 ± 1.9 mm and a length of 2.1 ~ 15.8 with an average of 10.0 ± 2.5 mm. When the occluder was in place, the 2DE and CDFI were used to monitor the residual shunt in real time. The indicators of instantaneous, 5, 10, 15, 20, 25 and 30 min were recorded in 7 phases including residual shunt type, ratio and Shunt beam width changes. Results: (1) Immediately after occluder positioning, 19 cases (18.6%) of 102 patients had no residual shunt and 83 (81.4%) patients had residual shunt. In patients with residual shunt, In the CDFI dynamic monitoring, all the central residual shunt bundles were detected in 41, and the edge-type residual shunt bundles were 133 (width <2mm 102, width ≥2mm 31); (2) Within 15 min, most of the residual red blood flow disappeared within 10 min; 95% of the marginal residual shunt with width less than 2 mm disappeared on their own after 25 min; while 5 remained undisturbed shunt widths were less than 1 mm at 30 min; while those with width ≥ 2 mm 6% of shunt disappeared on its own in 30 minutes, 94% of the shunt disappeared on its own, and its width did not change significantly in all stages; residual shunt of marginal residual shunt with width less than 2mm and ≥2mm remained at 5% And 94% (P <0.001). Conclusion: Echocardiography dynamic monitoring PDA PDA after the closure of the residual shunt change is simple and feasible, alternative radiography; marginal residual shunt width ≥ 2mm, duration 30min without significant changes should be replaced occluder, so as to avoid Cause long-term residual diversion.