CAJ | 학술논문

目的总结肺血管发育不良复杂先天性心脏病(CHD)外科治疗经验.方法回顾性分析2000年1月-2013年12月收治的252例肺血管发育不良复杂CHD患儿的临床资料,均行心脏超声、MR或64排螺旋CT等检查明确诊断.根据左右心室发育、肺动脉发育情况选择适当手术方式,行各类解剖矫治术215例、生理矫治及姑息性手术37例.术后密切观察循环功能、呼吸功能的变化,维持适当容量负荷及内环境平衡,并给予充分镇静、适当体位、循环及呼吸功能支持.结果体外循环(116.41±26.34)min,主动脉阻断(72.65±25.41) min,术后呼吸机辅助(18.42±11.83)h,术后多巴胺平均用量(8.02±2.14)mg·kg-1·min-1,术后ICU监护(71.5±25.4)h,术后住院(9.7±5.4)d.手术死亡13例,手术病亡率5.16％;各类手术并发症54例,发生率21.43％.随访时间0.5～10年,1例改良B-T分流患者术后1年心脏超声示人工血管闭塞.4例患者超声示右室流出道处钙化伴有轻度狭窄,未特殊处理.全腔静脉肺动脉连接术后肺动静脉瘘1例,随访中远期无死亡病例.结论充分的术前评估,合理的手术预案,正确的手术方法可提高手术疗效,降低手术并发症发生率及手术死亡率.
목적 총결폐혈관발육불량복잡선천성심장병(CHD)외과치료경험.방법 회고성분석2000년1월-2013년12월수치적252례폐혈관발육불량복잡CHD환인적림상자료,균행심장초성、MR혹64배라선CT등검사명학진단.근거좌우심실발육、폐동맥발육정황선택괄당수술방식,행각류해부교치술215례、생리교치급고식성수술37례.술후밀절관찰순배공능、호흡공능적변화,유지괄당용량부하급내배경평형,병급여충분진정、괄당체위、순배급호흡공능지지.결과 체외순배(116.41±26.34)min,주동맥조단(72.65±25.41) min,술후호흡궤보조(18.42±11.83)h,술후다파알평균용량(8.02±2.14)mg·kg-1·min-1,술후ICU감호(71.5±25.4)h,술후주원(9.7±5.4)d.수술사망13례,수술병망솔5.16％;각류수술병발증54례,발생솔21.43％.수방시간0.5～10년,1례개량B-T분류환자술후1년심장초성시인공혈관폐새.4례환자초성시우실류출도처개화반유경도협착,미특수처리.전강정맥폐동맥련접술후폐동정맥루1례,수방중원기무사망병례.결론 충분적술전평고,합리적수술예안,정학적수술방법가제고수술료효,강저수술병발증발생솔급수술사망솔.
Objective To summarize the surgical treatment of congenital heart diseases (CHD) with diminutive pulmonary vessels.Methods From Jan.2000 to Dec.2013,the clinical data of 252 children of CHD with diminutive pulmonary vessels in our department were analyzed retrospectively.Mter the diagnosis was confirmed by performing cardiac echocardiography,magnetic resonance imaging or spiral CT and other tests,an appropriate surgery was selected according to the development of left and right ventricular and pulmonary arteries.Anatomical correction surgery was performed in 215 cases,and physical or palliative surgery was performed in other 37 cases.All cases were given full sedation,proper posture,circulation and respiratory support after the operation.Results The cardiopulmonary bypass time was (116.41±26.34) min,the aortic cross-clamping time was (72.65 ± 25.41) min,the postoperative ventilation time was (18.42 ± 11.83) min,the average amount of application dopamine was (8.02 ±2.14)mg · kg-1 · min-1,intensive care time was (71.5 ± 25.4) h,postoperative hospital stay time was (9.7 ±5.4) days.Operative death and surgical complications occurred in 13 and 54 cases respectively.The followup time was from six months to ten years.The artificial material of a patient was obstructed completely one year later after B-T shunting procedure.Calculation nearby right ventricular outflow tract occurred in 4 cases without unusual function.One case underwent total cava pulmonany correction operation suffered from pulmonary vessels fistula 4 years later.There was no death in middle and long term follow-up.Conclusions The objective and comprehensive assessment of preoperative imaging,the correct choice of operation and postoperative care and treatment can greatly improve the surgery,reduce the incidence of surgical complications and mortality.