303例右室双出口手术后早期转归  

Early surgical results in patients with double outlet right ventricle

作　　者：徐卓明[1] 陈玲[1] 苏肇伉[1] 史珍英[1] 徐志伟[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2005年第1期15-17,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委科研基金资助 (0 0 4 1 1 90 83)

摘　　要：目的　总结右室双出口 (DORV)病例的术后处理及不同外科术式的早期转归。方法　 1988年 1月至 2 0 0 3年 12月期间收治 30 3例DORV病儿 ,按室间隔缺损 (VSD)的部位分为主动脉下VSD ,肺动脉下VSD ,双动脉下VSD和远离大动脉下VSD 4组。总结比较不同外科术式术后的并发症和死亡率及其原因。结果　再手术 18例 ,死亡 2 9例 ,死亡率为 9 6 % ,其中肺动脉下VSD死亡率最高 ,为 2 4 . 4 % (χ2 =14 . 12 ,P <0 . 0 1) ;根治术和姑息术的死亡率分别为 10 . 6 %和 6 . 6 % (χ2 =1. 0 3,P >0 .0 5 )。死亡原因主要是低心排血量综合征 (LCOS) ,占 82 . 6 % ;其也是术后主要并发症 ,占 31 .0 %。结论　LCOS是术后主要并发症和死亡的高危因素。有效预防和控制LCOS是取得治疗成功的关键。Objective To review postoperative management in children with double outlet right ventricle (DORV), and observed the early surgical results. Methods From January 1988 to December 2003, 303 patients with DORV underwent surgical repair. The patients were divided into four groups, group I with sub-aortic VSD, group II with sub-pulmonary VSD, group III with doubly committed VSD, and group IV with non-committed VSD. Results 18 patients required reoperation. There were 29 postoperative deaths, with a mortality of 9.6%. In the group II, the mortality rate was as high as 24.4%. The main complication and death cause was low cardiac output syndrome. Conclusion Low cardiac output syndrome is the major risk factor after repair of double outlet right ventricle. Effective prophylaxis and control of low cardiac output syndrome is a useful strategy.

关 键 词：右室双出口 早期转归 手术后 低心排血量综合征 外科术式 LCOS 2003年 1988年 室间隔缺损 预防和控制 VSD 死亡率 并发症 术后处理 DORV 死亡原因 高危因素 肺动脉 主动脉 大动脉 再手术 姑息术 根治术 

分 类 号：R726.5[医药卫生—儿科]