Worry gets involved and treats first: It is stifled and

Worry gets involved and treats first: It is stifled and inadvisable to meet with the hole
Staff reporter Tan Jia

Our country nearly has 200,000 first every year worry infant was born, the annual hospitalization cost is up to 13 billion yuan. Over ten thousand infants treat and get well through getting involved every year.

At present, the cardiovascular disease hospital is as cardiovascular vessel disease of Ministry of Public Health (get involved in worry first) outside the mound of appointed Chinese Academy of Medical Sciences of Ministry of Public Health Medical the intersection of quality and control centre, Beijing cardiovascular disease get involved, treat the control centre of quality, set up in institute these even. Responsible for first worry gets involved medical treatment outside the mound of Chinese Academy of Medical Sciences working the cardiovascular disease hospital radiates the head of the department, gets involved in good professor Jiang Shi, Deputy Director of rescue center, and introduces, at present, worry gets involved in the total success rate of treatment among 92.3% to 99.6% first in our country, the complication incidence is among 1.97% to 4.45%, mortality is smaller than 0.11%. Worry get involved, treat with little effectual wound their first and short, the intersection of complication and advantage such as being little get the extensive employing day by day clinically hospital stays.

In the cardiovascular disease of our country beginning to be implemented on July 1 this year gets involved and treats the straight newspaper of the case, congenital heart disease ( First worry) It is an important content among them to get involved and treat. This initiate people until worry get involved, treat the standardized concern first again too.

" can't meet with the hole ing is stifled "

Mushroom umbrella, taking the stoppers of the spring steel rim, round of the cilium in post form With close in the intersection of apparatus and type, enrich constantly and improve, get involved, treat, can finish heart and the intersection of trunk and the intersection of development and odd-shaped " check, leak, fill a vacancy " well . Good to emphasize worry must grasp indication to treat strictly while getting involved first especially too Shi Jiang, " can't meet with the hole ing is stifled " .

He says, on the treatment not closed in the simple artery conduit, have got involved and treated and already basically substituted the surgery for example, the success rate of operation is generally higher than 98%. But if the artery conduit has not closed and amalgamated artery high pressure of severe lung, should make further detailed inspection. Some cases are unsuitable to adopt getting involved to treat, need taking and reducing the medicine in the artery pressure of lung. For example the artery conduit amalgamating artery high pressure of severe lung partly has not closed a patient, the high pressure in the lung artery actually could pass the loophole not closed " Reduce pressure " . After and implement by getting involved in technology and close ining, " there is not place that is released " at the artery pressure of lung ,Instead apt to lead to the fact patient pressure increase and appear the intersection of room and quiver, the intersection of heart and the intersection of person who park and symptom suddenly sharply in the heart.

Jiang Shi is good to especially emphasize, amalgamates artery high pressure of severe lung different to explain to atrial septal defect of the small diameter, can't close in blindly either, must look for the reason of the artery high pressure of lung carefully, choose appropriate therapeutic method according to the circumstances, otherwise it will cause this kind of patient's condition to worsen to close in simply, even die.

Jiang Shi is good also says, the tiny artery conduit briefing on there are only ultrasonic electrocardiogramsing has not been closed, and the infant and pre-school children not big of room of every room of heart, if can not hear the noise, the infant has no symptom, can follow up a case by regular visits to regularly, it is treated that it needn't be eager to get involved. Because infant's weight is light and the blood vessel relatively detailed, the blood vessel complication incident when being got involved and treated, such as form thrombus,etc.. In addition, often need general anesthesia at the time of infant and pre-school children's treatment, this may bring certain potential risk too. So, wait for these some infants to close in after growing up, in order to improve success rate and lower the incidence of complication.

On treatment of atrial septal defect, want, prevent " stop up on every hole " from too Excessively therapeutic inclination. Good to say if flawed or damaged edge better in terms, there is certain thickness, getting involved can basically substitute the surgery to treat Shi Jiang. A small mushroom umbrella can fill in the flawed or damaged place to fit together perfectly, but if the flawed or damaged diameter is relatively small, have not caused the atrium dextrum room to increase, can follow up a case by regular visits to regularly, it needn't be eager to put the closing in device. In addition, the infant may also heal some defect naturally following growing, does not need to treat. If membrane week department ventricular septal defect of child of nearly 1/4 can be closed naturally.

"Put the mushroom umbrella of the heart, should follow the child's life. So doctors must have clear diagnosis and sufficient reason before putting, don't cause unnecessary economy and psychological burden to infant and family. " It is said that Jiang Shi is good.

Watch out for serious later period complication

Good to remind, say until worry get involved complication need, enhance vigilance too various later period not treating first Shi Jiang.

The closing in device is lossed to let doctor and patient most " Disturbing " Thing. The closing in device losses the great majority and happens in the skill, postoperative some happens after getting back to the ward, but may happen in later time. It is reported abroad, one accepts the patient who closes in the skill is getting involved in one year after the operation and checking and discovering, the mushroom umbrella lossed " Go downstream " Have fallen to in the blood vessel of the left thigh. Once loss the closing in device, need " escaping " Block taking out,need to adopt if necessary by surgery.

Because the heart, in beating continuously, if the mushroom umbrella present position nears the edge of atrium or the aorta root rises, the long-term one " Beat " Also may cause the edge of the mushroom umbrella to denude pericardium tissue and aorta sinus constantly, cause and cure the source aorta finally- Atrium " Lou " Or atrium wall break, cause pericardium accumulate liquid, heart, pigeonhole the intersection of person who fill and serious complication. The emergence probability of this kind of complication is generally lower than 0.1%, but can't relax vigilance.

Good to say he it meets to be too such " scarce " in clinic Shi Jiang Case. One 10 -year-old boy accept, close in because of atrial septal defect postoperative, resume very smoothly. But the chest of the unidentified reason appears suddenly to ache, uncomfortable in chest in postoperative 1 and a half month. The ultrasonic electrocardiogram reveals the infant presents the pericardium to store up the liquid, implements pericardium drainage at once, future trouble pulls through in 12 hours.

"This medical organization that got involved in launching worry first and treated too has put forward the requirement. The closing in device takes off and lags behind and needs apparatus such as ' the snare device ' and entangles and takes out the block device lossed, when being unable to take out or meet other emergency, there should be surgical doctors ' rescues the field ' " . Good to say specific patient present person who close in take off backwardness, because local technological condition limited and unable to take out Shi Jiang, should go to the hospital of higher level to implement the surgery as soon as possible.

Jiang Shi is good to think, the choice of the operation opportunity is very important too. Get involved with coronary heart disease it is emergency call under an urgent state that handle the difference partly, it is treated that congenital heart disease gets involved to select a time the treatment. So, the doctor should get involved and treat while choosing patient's health to be good. If the patient has cold and fever or other infection in a recent month, it should not be eager to get involved and treat, otherwise may cause the potential risk of membrane inflammation and serious complication in the infective heart. Want, monitor every physiological index of patient closely while being postoperative, postoperative 1 - 3 - 6 - 12 - 24 take to go on and reexamine regularly month.

Get involved, it treats itself to be one complicated meticulous technology, " grotesque " Heart malformationses inborn last difficulty even more. Jiang Shi is good to point out, should not merely have the changes of structure of normal heart blood vessel and heart structure, blood dynamics caused by deformity at fingertips while getting involved in the doctor in worry that first, be familiar with the cardiovascular vessel image of pursuing etc. aroused in interest of the X-ray, supersound and gain knowledge at the same time. The doctor should accept that hold the card on duty after the standardization is trained, by improving the clinic diagnosis level, try hard to avoid the emergence of complication.


Chaining

The technology of getting involved applies to first the worry treatment starts to used the shaping skill of the sacculus to treat the lung artery at first one was narrow in the eighties of last century. With getting involved in therapeutic material and constant progress of the craft, especially the appearance of Amplatzer closing in device, the technology of getting involved is used for treating atrial septal defect of heart and artery conduit and has not closed gradually. After the 2000, domestic person who close in put clinical practice into, make our country worry get involved, treat, enter at full speed developing issue first, treat the example to count and rise by a wide margin.

It is reported, the involvement treatment of worry is fallen into two categories first: One kind is expanded through the sacculus " Widen " Blood vessel and valve have narrow places, another kind utilizes various " stoppers " There should not be unusual passway that hearts separated by defect and blood vessel to come to close in. In atrial septal defect, ventricular septal defect, the intersection of artery and conduit close, in the worry treatment the intersection of lung and the intersection of artery and 4 kinds of narrow most common ones, the technology of getting involved can exhibit one's skill.

According to the incomplete statistics, worry gets involved and treats the case for several every years in more than 13000 first in the area of continent of our country at present, more than hospitals in the continent area 120 can all launch first worry get involved and treat. The statistical data coming from 18 large medical centres such as Beijing, Shanghai, Guangzhou reveal, by March of 2008, 18 large-scale medical centres will finish first together worry get involved and treat 36072, among them the artery conduit has not closed and reached 10580, 10059 cases of atrial septal defect, 9660 cases of ventricular septal defect, a 4886 shaping skills of lung artery. In addition, the technology of getting involved is also used in lung sound pulse Lou, coronary artery Lou, aorta sinus tumour breaking and such inborn and cardiovascular and odd-shaped treatments as the aorta is drawn back narrowly.



Worry gets involved and treats first: It is stifled and inadvisable to meet with the hole