CAJ | 학술논문

目的分析动脉调转术治疗新生儿室间隔完整型大动脉转位(D-TGA/IVS)临床结果及危险因素.方法回顾分析上海儿童医学中心2000年1月至2006年12月共62例行动脉调转术治疗的D-TGA/IVS新生儿围术期临床结果.手术年龄15 h～28 d,平均(8.91±8.04)d,体重2.30～4.40 kg,平均(3.34±0.44)kg.手术均在深低温低流量体外循环下和深低温停循环下进行.结果全组死亡6例,住院病死率9.7%.其中急诊手术组和非急诊手术组病死率分别为15.6%(5/32)和3.3%(1/30),小年龄组(年龄≤14 d)和大年龄组(年龄15～28 d)病死率分别为8.0%(4/50)和16.7%(2/12),冷晶体停搏液组和冷含血晶体停搏液组病死率分别为4.0%(1/25)和13.5%(5/37).典型冠状动脉组和非典型冠状动脉组病死率分别为8.3%(4/48)和14.3%(2/14).对应各组间病死率差异均无统计学意义.急诊手术组(148.52±193.98)与非急诊手术组(66.38±34.58)的术后插管时间差异有统计学意义(P=0.039),重症监护时间(P=0.088)、术后住院时间(P=0.100)差异无统计学意义;小年龄组与大年龄组、晶体停搏液组与含血停搏液组、典型冠状动脉组与非典型冠状动脉组的术后插管时间、重症监护时间、术后住院时间差异均无统计学意义.结论新生儿DTGA/IVS行动脉调转术治疗,效果满意.术前明确诊断,纠正酸中毒、维持动脉导管开放,积极改善术前一般情况,术中精心的手术设计和操作,术后应用综合治疗措施,积极防治各种并发症,是降低围术期病死率的关键.早期诊断,早期手术,尽量减少急诊手术,可减少术后呼吸机辅助时间,有利患儿术后顺利康复.
목적 분석동맥조전술치료신생인실간격완정형대동맥전위(D-TGA/IVS)림상결과급위험인소.방법 회고분석상해인동의학중심2000년1월지2006년12월공62례행동맥조전술치료적D-TGA/IVS신생인위술기림상결과.수술년령15 h～28 d,평균(8.91±8.04)d,체중2.30～4.40 kg,평균(3.34±0.44)kg.수술균재심저온저류량체외순배하화심저온정순배하진행.결과 전조사망6례,주원병사솔9.7%.기중급진수술조화비급진수술조병사솔분별위15.6%(5/32)화3.3%(1/30),소년령조(년령≤14 d)화대년령조(년령15～28 d)병사솔분별위8.0%(4/50)화16.7%(2/12),랭정체정박액조화랭함혈정체정박액조병사솔분별위4.0%(1/25)화13.5%(5/37).전형관상동맥조화비전형관상동맥조병사솔분별위8.3%(4/48)화14.3%(2/14).대응각조간병사솔차이균무통계학의의.급진수술조(148.52±193.98)여비급진수술조(66.38±34.58)적술후삽관시간차이유통계학의의(P=0.039),중증감호시간(P=0.088)、술후주원시간(P=0.100)차이무통계학의의;소년령조여대년령조、정체정박액조여함혈정박액조、전형관상동맥조여비전형관상동맥조적술후삽관시간、중증감호시간、술후주원시간차이균무통계학의의.결론 신생인DTGA/IVS행동맥조전술치료,효과만의.술전명학진단,규정산중독、유지동맥도관개방,적겁개선술전일반정황,술중정심적수술설계화조작,술후응용종합치료조시,적겁방치각충병발증,시강저위술기병사솔적관건.조기진단,조기수술,진량감소급진수술,가감소술후호흡궤보조시간,유리환인술후순리강복.
Objective To assess the outcome and the risk factors of arterial switch operation (ASO)on transposition of the great arteries with intact ventricular septum(TGA/IVS)in infants younger than 4 weeks of age.Methods Sixty-two neonates with TGA/IVS who underwent primary ASO from Jan.2000 to Dec.2006 were investigated retrospectively.The age at operation ranged from 15 hours to 28 days(mean 8.91±8.04 d),and the weight ranged from 2.30 kg to 4.40 kg(mean 3.34kg±0.44 kg).According to the clinieal presentation,the patients were divided into emergent group(n =32)and selective group(n=30).Acted on the age at operation,they were divided into younger age group(age≤14 day,n=50)and elder age group(age 15-28 day,n=12).Surgical correction was performed under cardiopulmonary bypass with deep hypothermia and low-flow(DHLF)perfusion or circulatory arrest(DHCA).Results There were 56 cases survived and 6 patients died postoperatively(mortality 9.7%).The mortality rate based on different groups was calculated respectively.The mortality rate were 1 5.6%(5/32)and 3.33%(1/30)in emergent group and selective group;8.0%(4/50)and 16.7%(2/12)in younger age group and elder age group;4.0%(1/25)and 13.5%(5/37)in cold crystalloid cardioplegia group and cold blood cardioplegia group,and 8.3%(4/48)and 14.3%(2/14)in typical coronary artery group and non typical coronary artery group.There was no statistics difference in the mortality between each paired group and in the length of ICU stay as well(10.89 d±9.61 d versus 7.62 d±3.07 d,P=0.088)and the hospitalization(16.89 d±11.21 d vs.13.07 d±4.83 d,P=0.100)between the emergent group and selective group.The duration of postoperativeventilation was significantly prolonged for the emergent group(148.52 h±193.98 h vs.66.38 h±34.58 h,P=0.039).Conclusions The efficacy of arterial switch operation on D-TGA/IVS in neonates is satisfactory.A confirmed diagnosis,adequate rectified acidosis,pharmacologic administered to open the PDA and improved status of the newborns,specific designed procedure of repair and optimal postoperattve care are key points to decrease the perioperative mortality.An adequate preoperative preparation instead of performance of emergency repair on the patients in unstable condition can reduce postoperative ventilation time and contribute to uneventful recovery.