跳到主要內容

臺灣博碩士論文加值系統

(3.235.120.150) 您好!臺灣時間:2021/08/03 06:10
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:李昱聲
研究生(外文):Yu-Sheng Lee
論文名稱:心房中隔缺損病童經由心導管置放關閉器後肺功能的變化
論文名稱(外文):Pulmonary function changes in children after transcatheter closure of atrial septal defect
指導教授:宋文舉
指導教授(外文):Wen-Jue Soong
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:急重症醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:53
中文關鍵詞:心房中隔缺損肺功能肺高壓肺功能量計
外文關鍵詞:Atrial septal defectPulmonary functionPulmonary hypertensionSpirometry
相關次數:
  • 被引用被引用:0
  • 點閱點閱:285
  • 評分評分:
  • 下載下載:36
  • 收藏至我的研究室書目清單書目收藏:0
本研究目的為探討心房中隔缺損病童,經由心導管置放關閉器後,其肺功能指標與肺功能分類結果的變化。共有五十五名心房中隔缺損病童參與本研究,所有參與研究的病童於經由心導管置放關閉器前、置放關閉器三天後、以及置放關閉器六個月後接受肺功能的檢測,所使用的肺功能檢測方法為肺功能量計(Spirometry),測定的肺功能指標包括用力肺容量(Forced vital capacity, FVC)、第一秒吐氣量(Forced expired volume in one second, FEV1)、用力肺容量與第一秒吐氣量的比值 (FEV1/FVC)、最大呼氣量(Peak expiratory flow, PEF)、及百分之二十五至百分之七十五之平均用力吐氣氣流(Mean forced expiratory flow during the middle half of the FVC, FEF25-75)。此外,根據肺功能指標將各受測者分類為正常肺功能、阻塞型(Obstructive)肺功能缺陷、及侷限型(Restrictive)肺功能缺陷,評估經由心導管置放關閉器後,對於心房中隔缺損病童肺功能的影響。經由心導管置放關閉器前,心房中隔缺損病童其平均PEF (84 ± 24%, p = 0.040)及平均FEF25-75 (76 ± 22%, p = 0.010)明顯較參考標準值低,但只有平均FEF25-75於置放關閉器三天(78 ± 24%, p = 0.010)以及六個月(81 ± 24%, p = 0.040)後,明顯較參考標準值低。經由心導管置放關閉器六個月後,平均FVC (94 ± 9% vs. 98 ± 15%, p = 0.034)與平均FEV1 (90 ± 20% vs. 96 ± 19%, p = 0.008)較置放關閉器前明顯改善。個別評估其肺功能,心房中隔缺損未合併肺高壓者,經由心導管置放關閉器後,有較好的肺功能(χ2 = 8.333, p = 0.044)。心房中隔缺損病童的肺功能障礙,主要發生於周圍呼吸道明顯的氣流限制,經由心導管置放關閉器後,肺功能可獲得改善,且心房中隔缺損未合併肺高壓者預後較好。吾人認為心房中隔缺損病童應監測其肺功能變化,且應在未合併肺高壓前,經由心導管置放關閉器矯正其血流分流。
This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at three days and six months after transcatheter procedure. Forced vital capacity (FVC), forced expired volume in one second (FEV1), FEV1 to FVC ratio (FEV1/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF25-75) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF25-75 (84 ± 24%, p = 0.040 and 76 ± 22%, p = 0.010 respectively) at baseline, with FEF25-75 reduced significantly at three days and six months (78 ± 24%, p = 0.010 and 81 ± 24%, p = 0.040 respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 ± 19% vs. 98 ± 15%, p = 0.034) and FEV1 (90 ± 20% vs. 96 ± 19%, p = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (χ2 = 8.333, p = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops.
目錄…………………………………………………………………………..i
論文電子檔著作權授權書……...………………………………………….vi
論文審定同意書…...……….……………………………………………….v
誌謝….........……………………………………………...…………………vi
中文摘要……….........……………………………………………….........viii
英文摘要…..…………………………………………………………….......x
英文縮寫…………………………………………………………………...xii

第一章 緒論…………………………………………………………….......1
第一節 心房中隔缺損簡介………………………........................2
第二節 心房中隔缺損對肺功能的影響……………………........2
第三節 心房中隔缺損之修補方式………………………………3
第四節 心房中隔缺損合併肺高壓………………………………3
第五節 心房中隔缺損可能發生之急重症………………………4
第六節 本論文之研究目的……...………………………….........4
第二章 研究方法……………………………………………………….......5
第一節 研究對象..………………………………..........................6
第二節 心臟血流動力學之測量..………………………………..6
第三節 肺功能指標之測量與分析………………………............7
第四節 肺功能分類之變化..………………………………..........8
第三章 統計分析..……………………………….......................................10
第四章 結果..………………………………...............................................12
第一節 研究對象的基本資料..………………………………....13
第二節 研究對象的各項血流動力學指標..……………………13
第三節 研究對象的各項肺功能指標..…………………………13
1、 各項肺功能指標與參考標準值之比較..……………...14
2、 各項肺功能指標於置放關閉器前後之比較..………...14
3、肺功能分類於置放關閉器前後之比較..……………….15
第五章 討論..………………………………...............................................17
第一節 心房中隔缺損肺功能障礙之原因..……………………18
第二節 心房中隔缺損於置放關閉器後肺功能指標改善之原因
…...…………………………………………………..…..19
第三節 心房中隔缺損合併肺高壓對於肺功能之影響………..20
第四節 心房中隔缺損於置放關閉器後肺功能分類變化之原因
…………………………………………………………...21
第五節 以肺功能量計追蹤心房中隔缺損病童肺功能改變之臨
床意義……………………………….…...……………...23
第六節 本研究之限制…………………………………………..23
第六章 結論……………………………………………………………….25
表與圖……………………………………………………………………...27
表一…………………………………………………………….…28
表二…………………………………………………………….…29
表三…………………………………………………………….…30
圖一……………………………………………………………….31
參考文獻…………………………………………………………………...32
1. Dickinson DF, Arnold R, Wilkinson JL. Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J 1981;46(1):55-62.
2. Graham TP, Jr. Ventricular performance in congenital heart disease. Circulation 1991;84(6):2259-2274.
3. Rabinovitch M, Keane JF, Norwood WI, Castaneda AR, Reid L. Vascular structure in lung tissue obtained at biopsy correlated with pulmonary hemodynamic findings after repair of congenital heart defects. Circulation 1984;69(4):655-667.
4. Cowen ME, Jeffrey RR, Drakeley MJ, Mercer JL, Meade JB, Fabri BM. The results of surgery for atrial septal defect in patients aged fifty years and over. Eur Heart J 1990;11(1):29-34.
5. Davies H, Gazetopoulos N. Lung function in patients with left-to-right shunts. Br Heart J 1967;29(3):317-326.
6. De Troyer A, Yernault JC, Englert M. Mechanics of breathing in patients with atrial septal defect. Am Rev Respir Dis 1977;115(3):413-421.
7. Lubica H. Pathologic lung function in children and adolescents with congenital heart defects. Pediatr Cardiol 1996;17(5):314-315.
8. Schofield PM, Barber PV, Kingston T. Preoperative and postoperative pulmonary function tests in patients with atrial septal defect and their relation to pulmonary artery pressure and pulmonary:systemic flow ratio. Br Heart J 1985;54(6):577-582.
9. Sulc J, Andrle V, Hruda J, Hucin B, Samanek M, Zapletal A. Pulmonary function in children with atrial septal defect before and after heart surgery. Heart 1998;80(5):484-488.
10. Sulc J, Samanek M, Zapletal A. Lung function in atrial septal defect after heart surgery. Int J Cardiol 1992;37(1):15-21.
11. Yoshioka T, Kunieda T, Naito M, Fukunaga Y, Okubo S, Nakanishi N. Effects of pulmonary hemodynamics on lung function in adult patients with atrial septal defect. Jpn Circ J 1985;49(9):960-966.
12. Bedell GN, Adams RW. Pulmonary Diffusing Capacity during Rest and Exercise. A Study of Normal Persons and Persons with Atrial Septal Defect, Pregnancy, and Pulmonary Disease. J Clin Invest 1962;41(10):1908-1914.
13. Wood TE, McLeod P, Anthonisen NR, Macklem PT. Mechanics of breathing in mitral stenosis. Am Rev Respir Dis 1971;104(1):52-60.
14. Griffin AJ, Ferrara JD, Lax JO, Cassels DE. Pulmonary compliance. An index of cardiovascular status in infancy. Am J Dis Child 1972;123(2):89-95.
15. Wallgren G, Geubelle F, Koch G. Studies of the mechanics of breathing in children with congenital heart lesions. Acta Paediatr 1960;49:415-425.
16. Brochu MC, Baril JF, Dore A, Juneau M, De Guise P, Mercier LA. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation 2002;106(14):1821-1826.
17. Horvath KA, Burke RP, Collins JJ, Jr., Cohn LH. Surgical treatment of adult atrial septal defect: early and long-term results. J Am Coll Cardiol 1992;20(5):1156-1159.
18. Butera G, De Rosa G, Chessa M, Rosti L, Negura DG, Luciane P, Giamberti A, Bossone E, Carminati M. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol 2003;42(2):241-245.
19. King TD, Thompson SL, Steiner C, Mills NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 1976;235(23):2506-2509.
20. Bruch L, Parsi A, Grad MO, Rux S, Burmeister T, Krebs H, Kleber FX. Transcatheter closure of interatrial communications for secondary prevention of paradoxical embolism: single-center experience. Circulation 2002;105(24):2845-2848.
21. Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 2003;89(2):199-204.
22. Pedra CA, Pedra SR, Esteves CA, Cassar R, Pontes SC, Jr., Braga SL, Fontes VF. Transcatheter closure of secundum atrial septal defects with complex anatomy. J Invasive Cardiol 2004;16(3):117-122.
23. Barst RJ, McGoon M, Torbicki A, Sitbon O, Krowka MJ, Olschewski H, Gaine S. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;43(12 Suppl S):40S-47S.
24. Rao PS, Langhough R, Beekman RH, Lloyd TR, Sideris EB. Echocardiographic estimation of balloon-stretched diameter of secundum atrial septal defect for transcatheter occlusion. Am Heart J 1992;124(1):172-175.
25. Fischer G, Kramer HH, Stieh J, Harding P, Jung O. Transcatheter closure of secundum atrial septal defects with the new self-centering Amplatzer Septal Occluder. Eur Heart J 1999;20(7):541-549.
26. Beydon N, Davis SD, Lombardi E, Allen JL, Arets HG, Aurora P, Bisgaard H, Davis GM, Ducharme FM, Eigen H, Gappa M, Gaultier C, Gustafsson PM, Hall GL, Hantos Z, Healy MJ, Jones MH, Klug B, Lodrup Carlsen KC, McKenzie SA, Marchal F, Mayer OH, Merkus PJ, Morris MG, Oostveen E, Pillow JJ, Seddon PC, Silverman M, Sly PD, Stocks J, Tepper RS, Vilozni D, Wilson NM. An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007;175(12):1304-1345.
27. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J 2005;26(2):319-338.
28. Chang HL, Jeng MJ, Tsao PC, Kou YR, Soong WJ. Spirometric Reference Equations for Healthy Children Aged 3 to 6 Years. ATS 2005 San Diego International Conference 2005:Abstract Page: A183.
29. Giannelli S, Jr., Ayres SM, Buehler ME. Effect of pulmonary blood flow upon lung mechanics. J Clin Invest 1967;46(10):1625-1642.
30. Rosengart R, Fisbein M, Emmanouilides GC. Progressive pulmonary vascular disease after surgical correction (Mustard procedure) of transposition of great arteries with intact ventricular septum. Am J Cardiol 1975;35(1):107-111.
31. Corno A, Giamberti A, Giannico S, Marino B, Rossi E, Marcelletti C, Kirklin JK. Airway obstructions associated with congenital heart disease in infancy. J Thorac Cardiovasc Surg 1990;99(6):1091-1098.
32. deLorimier AA, Harrison MR, Hardy K, Howell LJ, Adzick NS. Tracheobronchial obstructions in infants and children. Experience with 45 cases. Ann Surg 1990;212(3):277-289.
33. de Lezo JS, Medina A, Romero M, Pan M, Segura J, Caballero E, Pavlovic D, Ortega JR, Franco M, Delgado A, Ojeda S, Mesa D, Lafuente M. Effectiveness of percutaneous device occlusion for atrial septal defect in adult patients with pulmonary hypertension. Am Heart J 2002;144(5):877-880.
34. Schoen SP, Kittner T, Bohl S, Braun MU, Simonis G, Schmeisser A, Strasser RH. Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study. Heart 2006;92(6):821-826.
35. Habre W, Schutz N, Pellegrini M, Beghetti M, Sly PD, Hantos Z, Petak F. Preoperative pulmonary hemodynamics determines changes in airway and tissue mechanics following surgical repair of congenital heart diseases. Pediatr Pulmonol 2004;38(6):470-476.
36. Konstantinides S, Geibel A, Olschewski M, Gornandt L, Roskamm H, Spillner G, Just H, Kasper W. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995;333(8):469-473.
37. Sachweh JS, Daebritz SH, Hermanns B, Fausten B, Jockenhoevel S, Handt S, Messmer BJ. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg 2006;81(1):207-213.
38. Vogel M, Berger F, Kramer A, Alexi-Meshkishvili V, Lange PE. Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects. Heart 1999;82(1):30-33.
39. Cherian G, Uthaman CB, Durairaj M, Sukumar IP, Krishnaswami S, Jairaj PS, John S, Krishnaswami H, Bhaktaviziam A. Pulmonary hypertension in isolated secundum atrial septal defect: high frequency in young patients. Am Heart J 1983;105(6):952-957.
40. Craig RJ, Selzer A. Natural history and prognosis of atrial septal defect. Circulation 1968;37(5):805-815.
41. Steele PM, Fuster V, Cohen M, Ritter DG, McGoon DC. Isolated atrial septal defect with pulmonary vascular obstructive disease--long-term follow-up and prediction of outcome after surgical correction. Circulation 1987;76(5):1037-1042.
42. Murphy JG, Gersh BJ, McGoon MD, Mair DD, Porter CJ, Ilstrup DM, McGoon DC, Puga FJ, Kirklin JW, Danielson GK. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990;323(24):1645-1650.
43. Dhillon R, Josen M, Henein M, Redington A. Transcatheter closure of atrial septal defect preserves right ventricular function. Heart 2002;87(5):461-465.
44. Ning SB, Fazal H, Cook D, Wood MM, Duncan WJ, Rowe RD. Right ventricular size and ventricular septal motion after repair of atrial septal defect in children. Can J Surg 1984;27(4):395-398.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top