中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2010年
3期
213-216
,共4页
黄晶晶%宓亚平%贾兵%陈张根%桂永浩
黃晶晶%宓亞平%賈兵%陳張根%桂永浩
황정정%복아평%가병%진장근%계영호
肺动脉瓣闭锁%心脏外科手术%心脏缺损%先天性%婴儿%新生
肺動脈瓣閉鎖%心髒外科手術%心髒缺損%先天性%嬰兒%新生
폐동맥판폐쇄%심장외과수술%심장결손%선천성%영인%신생
Pulmonary atresia%Cardiac surgical procedures%Heart defects,congenital%Infant,newborn
目的 总结室间隔完整型肺动脉闭锁(pulmonary atresia with intact ventricular septum,PAIVS)的治疗策略.方法 回顾性分析2003年7月至2008年7月在我院接受手术治疗的17例PAIVS新生儿的治疗和随访情况.结果 17例PAIVS新生儿,平均日龄(15.6±8.6)d,平均体重(3540±440)g.4例合并右心室严重发育不良,5例超声心动图提示窦状隙开放,1例合并三尖瓣闭锁,1例合并三尖瓣发育不良.手术包括单纯体肺分流3例,闭式肺动脉瓣切开联合体肺分流1例,单纯跨瓣补片2例,联合体肺分流和跨瓣补片11例.术后呼吸机使用平均(35.5±35.1)h,监护室滞留平均(8.7±5.9)d,平均住院(18.7±13.6)d.术后短期再次手术2例,包括延迟关胸术1例,加做体肺分流术1例.住院期间死亡2例(2/17,11.8%).死亡风险分析发现手术前已机械通气辅助呼吸与手术死亡有关(r=1.02,P<0.01).其余15例均获得随访,时间2个月至5年,平均19个月,随访期间无死亡病例.结论 PAIVS新生儿应积极早期手术,以三尖瓣大小,右心室解剖形态以及有无冠状动脉畸形为依据选择适当的治疗方式.制订个体化手术方案、强化围手术期各重要脏器功能支持和加强随访可获得较满意的手术生存率.
目的 總結室間隔完整型肺動脈閉鎖(pulmonary atresia with intact ventricular septum,PAIVS)的治療策略.方法 迴顧性分析2003年7月至2008年7月在我院接受手術治療的17例PAIVS新生兒的治療和隨訪情況.結果 17例PAIVS新生兒,平均日齡(15.6±8.6)d,平均體重(3540±440)g.4例閤併右心室嚴重髮育不良,5例超聲心動圖提示竇狀隙開放,1例閤併三尖瓣閉鎖,1例閤併三尖瓣髮育不良.手術包括單純體肺分流3例,閉式肺動脈瓣切開聯閤體肺分流1例,單純跨瓣補片2例,聯閤體肺分流和跨瓣補片11例.術後呼吸機使用平均(35.5±35.1)h,鑑護室滯留平均(8.7±5.9)d,平均住院(18.7±13.6)d.術後短期再次手術2例,包括延遲關胸術1例,加做體肺分流術1例.住院期間死亡2例(2/17,11.8%).死亡風險分析髮現手術前已機械通氣輔助呼吸與手術死亡有關(r=1.02,P<0.01).其餘15例均穫得隨訪,時間2箇月至5年,平均19箇月,隨訪期間無死亡病例.結論 PAIVS新生兒應積極早期手術,以三尖瓣大小,右心室解剖形態以及有無冠狀動脈畸形為依據選擇適噹的治療方式.製訂箇體化手術方案、彊化圍手術期各重要髒器功能支持和加彊隨訪可穫得較滿意的手術生存率.
목적 총결실간격완정형폐동맥폐쇄(pulmonary atresia with intact ventricular septum,PAIVS)적치료책략.방법 회고성분석2003년7월지2008년7월재아원접수수술치료적17례PAIVS신생인적치료화수방정황.결과 17례PAIVS신생인,평균일령(15.6±8.6)d,평균체중(3540±440)g.4례합병우심실엄중발육불량,5례초성심동도제시두상극개방,1례합병삼첨판폐쇄,1례합병삼첨판발육불량.수술포괄단순체폐분류3례,폐식폐동맥판절개연합체폐분류1례,단순과판보편2례,연합체폐분류화과판보편11례.술후호흡궤사용평균(35.5±35.1)h,감호실체류평균(8.7±5.9)d,평균주원(18.7±13.6)d.술후단기재차수술2례,포괄연지관흉술1례,가주체폐분류술1례.주원기간사망2례(2/17,11.8%).사망풍험분석발현수술전이궤계통기보조호흡여수술사망유관(r=1.02,P<0.01).기여15례균획득수방,시간2개월지5년,평균19개월,수방기간무사망병례.결론 PAIVS신생인응적겁조기수술,이삼첨판대소,우심실해부형태이급유무관상동맥기형위의거선택괄당적치료방식.제정개체화수술방안、강화위수술기각중요장기공능지지화가강수방가획득교만의적수술생존솔.
Objective A retrospective study was undertaken to evaluate the outcomes of the newborns with pulmonary atresia with intact ventricular septum(PAIVS),in order to delineate strategies for the optimal management of PAIVS. Methods From July 2003 to July 2008,17 neonates with PAIVS underwent surgical treatment.The mean age at operation was(1 5.6±8.6)d and the mean weight was(3.54±0.44)kg.Initial surgical treatment included:Blalock-Taussig shunt (BT shunt)in 2 cases,closed pulmonary valvotomy and BT shunt in 1 case,right ventricular outlet tract reconstruction(RVOTR)in 2 cases,RVOTR and BT shunt in 11 cases. Results The mean duration of mechanical ventilation and intensive care unit stay were(35.5±35.1)h and(8.7±5.9)d,respectively.Two early deaths were reported inside the hospital(2/17,11.8%).Multivariable analysis demonstrated that mechanical ventilation before surgery was the risk factor for in-hospital mortality(r=1.02,P<0.01).The rest 15 cases were followed up with the average time of 19 months(2 months to 5 years)and no death was reported. Conclusions Neonates with PAIVS should be operated early.Individualized treatment strategy and regular follow-up are helpful to achieve better short-term outcome.
