CAJ | 학술논문

目的探讨先天性心脏病重度肺动脉瓣狭窄外科治疗的手术效果.方法选择2006年10月至2013年1月共纠治重度肺动脉瓣狭窄患儿74例.男51例,女23例;年龄2个月～13岁(中位年龄26个月);体质量5～ 47 kg(中位数16kg).合并其他心脏畸形,其中动脉导管未闭(PDA) 20例,卵圆孔未闭(PFO) 22例,房间隔缺损(ASD) 32例,室间隔缺损(VSD) 13例,右心室双腔心4例.患儿均在全身麻醉体外循环下行一期根治术,46例行右心室流出道至肺动脉跨瓣补片加宽,28例经肺动脉切口行肺动脉瓣膜交界切开术.结果体外循环时间40～100 min(中位数72 min),主动脉阻断时间13～ 79 min(中位数43 min).术后呼吸机辅助呼吸4 ～128 h(中位数15 h),重症监护病房(ICU)滞留4～18d(中位数5d).全组手术顺利,无手术死亡病例.围术期并发症:1例术中发生室颤,经电除颤后转为正常,术后4例出现低心排综合征,8例出现顽固性低氧血症,2例气胸,2例胸腔积液,1例急性肾衰竭,1例肺不张.随访期患儿均行X线胸片、心电图和心脏彩超检查,术后心功能明显改善.结论重度肺动脉瓣狭窄病情发展快,易发生低心排综合征和低氧血症,早期诊断,早期手术,效果良好.手术的关键在于应用自体心包或带瓣心包补片合理加宽肺动脉,充分解除右心室流出道梗阻;同时提高术后监护水平,及时处理各种术后并发症.
목적 탐토선천성심장병중도폐동맥판협착외과치료적수술효과.방법 선택2006년10월지2013년1월공규치중도폐동맥판협착환인74례.남51례,녀23례;년령2개월～13세(중위년령26개월);체질량5～ 47 kg(중위수16kg).합병기타심장기형,기중동맥도관미폐(PDA) 20례,란원공미폐(PFO) 22례,방간격결손(ASD) 32례,실간격결손(VSD) 13례,우심실쌍강심4례.환인균재전신마취체외순배하행일기근치술,46례행우심실류출도지폐동맥과판보편가관,28례경폐동맥절구행폐동맥판막교계절개술.결과 체외순배시간40～100 min(중위수72 min),주동맥조단시간13～ 79 min(중위수43 min).술후호흡궤보조호흡4 ～128 h(중위수15 h),중증감호병방(ICU)체류4～18d(중위수5d).전조수술순리,무수술사망병례.위술기병발증:1례술중발생실전,경전제전후전위정상,술후4례출현저심배종합정,8례출현완고성저양혈증,2례기흉,2례흉강적액,1례급성신쇠갈,1례폐불장.수방기환인균행X선흉편、심전도화심장채초검사,술후심공능명현개선.결론 중도폐동맥판협착병정발전쾌,역발생저심배종합정화저양혈증,조기진단,조기수술,효과량호.수술적관건재우응용자체심포혹대판심포보편합리가관폐동맥,충분해제우심실류출도경조;동시제고술후감호수평,급시처리각충술후병발증.
Objective To evaluate the effectiveness of urgent surgical procedures for severe pulmonary valve stenosis in infants and children.Methods Seventy-four (51 male,23 female) children with severe pulmonary valve stenosis who received surgical correction were collected from Oct.2006 to Jan.2013.The age of patients ranged from 2 months to 13 years(median age was 26 months),and the body weight was 5-47 kg (median weight was 16 kg).Patients had other cardiac deformities,and among them 20 patients were associated with the patent ductus arteriosus (PDA),22 cases with patent foramen ovale (PFO),32 cases with atrial septal defect (ASD),13 cases with ventricular septal defect (VSD),and 4 cases with double-chambered right ventricle.Radical corrections were performed in all patients under hypothermic general anaesthesia with cardiopulmonary bypass.There were 46 patients undergoing transannular patching with autologous pericardial flake and 28 patients undergoing transarterial pulmonary valvotomy.Results Urgent operations were performed in all patients and no death occurred during surgery.Median bypass time was 72 minutes(ranging from 40 to 100 minutes) and median aortic cross-clamp time was 43 minutes (ranging from 13 to 79 minutes).The time for the use of respirator was 4-128 h (median time was 15 h),and ICU stay lasted 4-18 days (median time was 5 days).Perioperative complications:included 1 case of ventricular fibrillation during operation,after electrical shock the patient returned to normal;postoperative complications included low cardiac output syndrome (4 cases),refractory hypoxemia(8 cases),acute renal failure (1 case),pneumothorax (2 cases),hydrothorax (2 cases),atelectasis(1 case).All patients received chest radiography,electrocardiogram and echocardiography during hospital stay.As a result,postoperative cardiac function was improved significantly.Conclusions Low cardiac output syndrome and hypoxemia aften exist in severe pulmonary stenosis.If severe pulmonary stenosis is diagnosed and operated early,the prognosis is good.The key to this kind of surgery is the application of autologous pericardium or disc pericardium patching tor widening pulmonary artery appropriately,which fully rescind the right ventricular outflow tract obstruction.At the same time,the level of postoperative monitoring should be improved,and postoperative complications must be handled timely.