【作者】 郑杰洪；

【导师】 刘小清；

【作者基本信息】 汕头大学 ， 内科学， 2010， 硕士

【摘要】 目的:1.分析10年来住院病人中永存动脉干(PTA)临床特征的变化,评价PTA的疗效及其预后。2.对PTA患者进行生存质量分析。以SF-36量表为测量工具,从PF、RP、BP、GH、VT、SF、RE和MH八个维度评估PTA患者的QOL。方法:在广东省人民医院病案中收集1999年1月-2008年12月住院治疗的PTA患者。1999年1月-2003年12月收治的为第一组;2004年1月-2008年12月收治的为第二组。分别收集其性别、年龄、PTA类型、治疗方法、临床表现、辅助检查结果等,进行统计分析。对PTA患者进行随访,将其UCG及生长发育指标结果与正常同龄人群进行对比。并以住院治疗年龄大于14岁有阅读能力的非心脏病患者20例为对照组,以调查问卷的形式填写SF-36量表,进行数据的搜集、整理和统计分析。结果:1999年1月-2003年12月在广东省人民医院住院的PTA患者共65例,男女之比为3.06:1,其平均住院年龄中位数为838天(3-15286天);PTA病例数在第一、二个五年周期分别为30例及35例,第二个五年周期增加了5例(16.67%)。其中行手术治疗的PTA患者27例,术后存活19例,存活率70.37%;死亡8例,病死率为29.63%。PTA矫治术后MPA、AV、RV、LVDd、LVDs、C/T较前减小,LVEF、LVFS较前增加,其差别有统计学意义(P<0.05)。手术前后发生三尖瓣返流的例数为6例及9例,术后有10例发生RBBB。PTA幸存者的10年主要生长发育指标随访结果:平均身高155.69±13.53cm,体重45.18±12.57kg,胸围69.50±10.00cm,与正常城镇儿童体格生长发育标准相比其身高、体重、胸围等生长发育指标稍差,但其差别无统计学意义(P>0.05)。PTA患者的生存质量在PF、RP、BP、GH、VT、SF、RE、MH八个维度的得分分别为:83.00±6.75,74.40±9.28,15.00±13.45,45.00±17.16,69.50±11.17,86.25±14.96,40.00±40.98和50.00±20.41。对照组八个维度的得分分别为:93.25±10.17,75.75±32.44,17.15±24.28,55.75±11.73,65.25±9.25,74.37±15.95,71.66±42.26,66.80±9.00。PTA患者在PF(t=-2.87,P=0.008)、RP(t=-2.22,P=0.035)两个维度总分小于对照组,MH(t=-2.16,P=0.040)维度总分高于对照组,差别有统计学意义;而BP、GH、VT、SF、RE维度与对照组的差别无统计学意义(P>0.05)。结论:1. PTA的住院患者呈现增多的趋势,男性比例高于女性,与国内报道相似,高于国外报道。2.手术是治疗PTA的唯一有效方法,手术治疗后患儿左心室前、后负荷、左室射血功能改善。3.未行手术治疗的患者中未合并其他复杂先天性心脏畸形,肺循环有支气管动脉供应或主动脉侧支供应的PTA患者预后较好。4. SF-36量表是一个普适性的生存质量量表,有较好的信度、效度。PTA患者在PF、RP、BP、GH、RE方面的总分低于美国及中国人常模,其差别有统计学意义(P<0.05);在VT、SF、MH得分方面与美国及中国人常模的差别无统计学意义(P>0.05)。更多还原

【Abstract】 Objective1. To analyze the clinical characteristic of persistent truncus arteriosus (PTA) in the hospital patients during the past 10 years, evaluate the therapeutic efficacy and prognosis of PTAs.2. To evaluate the quality of life of PTAs from eight dimensions of PF, RP, BP, GH, VT, SF, RE and MH by using SF-36 scales as measuring tools.MethodsHospitalized PTAs from January, 1999 to December, 2008 were collected from Guangdong General Hospital medical records. The cases that were received and therapied in hospital from January, 1999 to December 2003 were in the first group and in January 2004 to December 2008 were in the second group. Data of gender, age, PTA types, treatment methods, clinical manifestations and auxiliary examination, etc were collected. Statistical analyses were done for the above variables. PTAs were followed-up. UCG and the growth and development outcomes were compared with the normal peer group. 20 cases of in-patients with other etiological factor who were non- heart disease and older than 14 years and had reading ability were chose as the control group. Questionnaire of SF-36 scale were asked and filled. Then data collection, collation and statistical analysis were done. ResultsThere were 65 cases of PTAs hospitalized in Guangdong General Hospital from January, 1999 to December, 2008; male to female ratio was 3.06:1. The median age of hospitalization was 838 days(3-15286days),The cases of PTAs in the first and second five-year cycle were 30 and 35. The cases in the second five-year cycle were increased for 5(16.67%). 27 cases of patients were received the surgical repair and 19 cases were survived. The survival rate was 70.37%. 8 cases were deceased.The mortality was 29.63%.The MPA, AV, RV, LVDd, LVDs and C / T were reduced after surgical repair. LVEF, LVFS were increased after repair. The difference was statistically significant (P <0.05). The cases that tricuspid valve regurgitation occurred before and after repair were 6 and 9. RBBB occurred in 10 cases after repair. 10 years follow-up of the main indicators of growth and development on PTA survivors were: mean height 155.69±13.53cm, mean body weight 45.18±12.57kg,mean chest circumference 69.50±10.00cm.The index of growth and development such as height , body weight , chest circumference ,etc in PTAs were lower than normal urban children, but there was no statistically significant.The scores of the eight dimensions of PF, RP, BP, GH, VT, SF, RE, MH in PTAs were as follows: 83.00±6.75,74.40±9.28,15.00±13.45,45.00±17.16,69.50±11.17,86.25±14.96,40.00±40.98 and 50.00±20.41,and in non-heart disease patients were: 93.25±10.17,75.75±32.44,17.15±24.28,55.75±11.73,65.25±9.25,74.37±15.95,71.66±42.26,66.80±9.00.In PTAs, PF(t=-2.87,P=0.008) and RP(t=-2.22,P=0.035) were lower, but MH (t=-2.16,P=0.040) were higher than the control group. The differences were statistically significant. There were not statistically significant in the dimensions of BP, GH, VT, SF, RE compared with the control group (P>0.05). Conclusions1. The number of hospitalized patients with PTA was increasing. The proportion of males was higher than females, which was similar to the reports from domestic, but higher than the reports from abroad.2. The only effective method of therapy for PTA was surgical treatment. After the surgical repair, the preload, after load and ejection function of left ventricular were improved.3. The followings had the better prognosis among patients without surgical treatment: with no combination of other complex congenital heart malformations, whose pulmonary circulation was supplied by bronchial artery and PTA had aortic collateral.4. SF-36 scale is a universal quality of life scale, which has good reliability and validity. The total score of PF, RP, BP, GH and RE in patients with PTA were lower than the norm of Americans and Chinese. The differences were statistically significant (P<0.05). In the dimensions of VT, SF, MH there were no statistically difference between patients with PTA and the norm of Americans and Chinese (P>0.05).更多还原