CAJ | 학술논문

目的回顾性分析房间隔留窗对完全性肺静脉异位引流(TAPVC)合并左心室发育不全患儿术后疗效的影响.方法收集2006年6月至2013年6月44例TAPVC合并左心室发育不全患儿资料.根据矫治手术中是否完全关闭房间隔缺损或卵圆孔,分为房间隔留窗组(A组,25例)和未留窗组(B组,19例),研究房间隔留窗对TAPVC合并左心室发育不全矫治术早、中期结果的影响.结果两组患儿年龄、体质量及左心室发育情况差异无统计学意义(P＞0.05),A、B两组主动脉阻断时间差异无统计学意义(P＞0.05),A组术中体外循环时间、术后呼吸机支持时间、正性肌力药物支持时间及ICU治疗时间均显著小于B组(P＜0.05).术后低心排血量综合征A组4例(16.00％),B组6例(31.58％);术后肺水肿A组1例(4.00％),B组2例(10.53％),组间差异均无统计学意义(P＞0.05).死亡3例(6.82％),A、B组各1例死于严重低心排血量综合征,B组另有1例死于严重感染及多脏器功能衰竭.术后随访结果提示部分患儿房间隔分流可功能性自愈,术后1年患儿左心室发育基本达到正常水平.结论手术矫治TAPVC合并左心室发育不全患儿时,术中房间隔留窗可作为促进患儿术后恢复的治疗策略.
목적 회고성분석방간격류창대완전성폐정맥이위인류(TAPVC)합병좌심실발육불전환인술후료효적영향.방법 수집2006년6월지2013년6월44례TAPVC합병좌심실발육불전환인자료.근거교치수술중시부완전관폐방간격결손혹란원공,분위방간격류창조(A조,25례)화미류창조(B조,19례),연구방간격류창대TAPVC합병좌심실발육불전교치술조、중기결과적영향.결과 량조환인년령、체질량급좌심실발육정황차이무통계학의의(P＞0.05),A、B량조주동맥조단시간차이무통계학의의(P＞0.05),A조술중체외순배시간、술후호흡궤지지시간、정성기력약물지지시간급ICU치료시간균현저소우B조(P＜0.05).술후저심배혈량종합정A조4례(16.00％),B조6례(31.58％);술후폐수종A조1례(4.00％),B조2례(10.53％),조간차이균무통계학의의(P＞0.05).사망3례(6.82％),A、B조각1례사우엄중저심배혈량종합정,B조령유1례사우엄중감염급다장기공능쇠갈.술후수방결과제시부분환인방간격분류가공능성자유,술후1년환인좌심실발육기본체도정상수평.결론 수술교치TAPVC합병좌심실발육불전환인시,술중방간격류창가작위촉진환인술후회복적치료책략.
Objective To evaluate the effect of keeping atrial septal fenestration in correction of total anomalous pulmonary venous connection (TAPVC) with left ventricular hypoplasia.Methods We reviewed 44 TAPVC patients between June,2006 and June,2013 in Shanghai Xinhua Hospital.According to whether keeping atrial septal fenestration during operation,patients were divided into group A(keeping fenestration,25 cases) and group B(no fenestration,19 cases).Retrospective statistical analysis was carried on the in-patient data and follow-up outcomes.Results No statistically significant differences between the two group on age,weight,left ventricular volume and crossclamp time (P ＞ 0.05).While cardiopulmonary bypass time,ventilation time,dosage of positive inotropic drugs,and ICU stay time of group A were shorter compares with group B (P ＜ 0.05).4 patients in group A (16.00％) suffered from low cardiac output syndrome (LCOS) postoperatively,and 6 in group B(31.58％).Pulmonary edema occurred in 3 patients,1 in group A(4.00％),and 2 in group B(10.53％).Total post-operative mortality was 6.82％ (3/44).2 cases died of serious LCOS(1 from group A,and the other from group B),1 cases died of infection and multiple organ dysfunction syndrome(group B).No significant difference of mortality was observed between two groups.Follow-up data showed some fenestrations can close naturally.Conclusion Keeping atrial septal fenestration can be done as a feasibility tactic in correction of TAPVC with left ventricular hypoplasia.