中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2015年
7期
466-469
,共4页
刘宇航%衣慧%温志杰%洪小杨%王辉%王刚%于文文%封志纯%周更须
劉宇航%衣慧%溫誌傑%洪小楊%王輝%王剛%于文文%封誌純%週更鬚
류우항%의혜%온지걸%홍소양%왕휘%왕강%우문문%봉지순%주경수
肺静脉异位引流%心脏外科手术%先天性心脏病%新生儿
肺靜脈異位引流%心髒外科手術%先天性心髒病%新生兒
폐정맥이위인류%심장외과수술%선천성심장병%신생인
Anomalous pulmonary venous connection%Cardiac surgical procedures%Congenital heart disease%Neonate
目的:报告新生儿心下型完全性肺静脉异位引流的矫治方法及效果。方法2009年10月至2015年1月,共纠治新生儿心下型完全性肺静脉异位引流13例。患儿出生6~28 d,平均(15.08±7.42)d,体重2.5~4.8 kg,平均(3.34±0.67)kg。所有手术均在浅低温高流量灌注下进行,3例患儿经右心房切口,切开房间隔,左心房后壁与肺静脉吻合;10例患儿采用心脏上翻法,左心房斜形切口与肺静脉无张力缝合。结果全组患儿手术顺利,无手术死亡病例。11例患儿术后延迟关胸,3例发生肺高压危象,6例保留房间隔缺损,3例使用临时心脏起搏器。除2例因低心排综合征于术后早期死亡,其余患儿均治愈出院。2例患儿术后反复出现肺部感染,心脏超声发现吻合口流速明显增快,其中1例失随访,1例再次手术解除肺静脉吻合口狭窄,痊愈出院。余9例随访1个月至5年。随访期均行心脏超声、X 线胸片、心电图检查。多数患儿心功能良好,心胸比例较术前明显缩小,肺淤血消失,心电图示窦性节律,吻合口血流速度正常。结论新生儿心下型完全性肺静脉异位引流病情危重,早期诊断、早期手术效果良好。
目的:報告新生兒心下型完全性肺靜脈異位引流的矯治方法及效果。方法2009年10月至2015年1月,共糾治新生兒心下型完全性肺靜脈異位引流13例。患兒齣生6~28 d,平均(15.08±7.42)d,體重2.5~4.8 kg,平均(3.34±0.67)kg。所有手術均在淺低溫高流量灌註下進行,3例患兒經右心房切口,切開房間隔,左心房後壁與肺靜脈吻閤;10例患兒採用心髒上翻法,左心房斜形切口與肺靜脈無張力縫閤。結果全組患兒手術順利,無手術死亡病例。11例患兒術後延遲關胸,3例髮生肺高壓危象,6例保留房間隔缺損,3例使用臨時心髒起搏器。除2例因低心排綜閤徵于術後早期死亡,其餘患兒均治愈齣院。2例患兒術後反複齣現肺部感染,心髒超聲髮現吻閤口流速明顯增快,其中1例失隨訪,1例再次手術解除肺靜脈吻閤口狹窄,痊愈齣院。餘9例隨訪1箇月至5年。隨訪期均行心髒超聲、X 線胸片、心電圖檢查。多數患兒心功能良好,心胸比例較術前明顯縮小,肺淤血消失,心電圖示竇性節律,吻閤口血流速度正常。結論新生兒心下型完全性肺靜脈異位引流病情危重,早期診斷、早期手術效果良好。
목적:보고신생인심하형완전성폐정맥이위인류적교치방법급효과。방법2009년10월지2015년1월,공규치신생인심하형완전성폐정맥이위인류13례。환인출생6~28 d,평균(15.08±7.42)d,체중2.5~4.8 kg,평균(3.34±0.67)kg。소유수술균재천저온고류량관주하진행,3례환인경우심방절구,절개방간격,좌심방후벽여폐정맥문합;10례환인채용심장상번법,좌심방사형절구여폐정맥무장력봉합。결과전조환인수술순리,무수술사망병례。11례환인술후연지관흉,3례발생폐고압위상,6례보류방간격결손,3례사용림시심장기박기。제2례인저심배종합정우술후조기사망,기여환인균치유출원。2례환인술후반복출현폐부감염,심장초성발현문합구류속명현증쾌,기중1례실수방,1례재차수술해제폐정맥문합구협착,전유출원。여9례수방1개월지5년。수방기균행심장초성、X 선흉편、심전도검사。다수환인심공능량호,심흉비례교술전명현축소,폐어혈소실,심전도시두성절률,문합구혈류속도정상。결론신생인심하형완전성폐정맥이위인류병정위중,조기진단、조기수술효과량호。
Objective To evaluate the effectiveness of urgent surgical correction for infra-cardiac total anomalous pulmonary venous connection(TAPVC)in neonates.Methods From October 2009 to Janu-ary 2015,13 patients with infra-cardiac TAPVC received surgical correction.The age of patients ranged from 6 to 28 days[(15.08 ±7.42)days],the body weight ranged from 2.5 to 4.8 kg [(3.34 ±0.67)kg].A median sternotomy was performed.Continuous cardiopulmonary bypass using bicaval cannulation with aortic cross-clamping and mild systemic hypothermia were used in all patients.Bi-atrial incision technique making anastomosis between the posterior left atrial wall and the vertical vein were employed in 3 cases.In the other 10 cases,the heart was elevated upward and to the right to expose the anomalous descending vertical vein to facilitate the anastomosis between the posterolateral left atrial wall and vertical vein.Results Emergent or subemergent operations were performed in all patients without surgical death.In the early stage after opera-tion,delayed sternal closure was employed in 1 1 patients,pulmonary hypertension crisis occurred in 3 pa-tients,small atrial septal defect was kept open for hemodynamic stabilization in 6 patients,temporary cardiac pacemaker for proper heart rate in 3 patients.All patients were uneventfully discharged except 2 patients died of severe low cardiac output syndrome.During the period of follow up,2 patients presented with recurrent pulmonary infection and signs of pulmonary venous obstruction including the increased flow speed at the site of anastomosis.One of 2 patients was lost of follow up and the other patient was uneventfully discharged after the second operation.The rest 9 patients received postoperative follow up for 1 month to 5 years,echocardio-graphy,X ray chest radiography,and electrocardiogram were performed during this period.As a result,all children had good cardiac function and with sinus rhythm on electrocardiogram and apparently reduced pul-monary congestion on radiography.No obstructive pulmonary venous return was observed on echocardio-graphy.Conclusion Corrective operation for infra-cardiac TAPVC in neonate on urgent basis may provide favorite outcomes.