Gore-tex管道重建前向性肺循环姑息性治疗法洛四联症合并肺动脉闭锁  

Restoration of anterior pulmonary circulation with Gore-tex conduit in first-stage palliation of tetralogy of Fallot with pulmonary atresia

作　　者：刘锦纷[1] 陈会文[1] 苏肇伉[1] 丁文祥[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》2006年第2期73-75,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评价Gore-tex管道重建前向性肺循环姑息性治疗法洛四联症合并肺动脉闭锁的价值。方法 2003年1月至2005年7月14例病儿接受此治疗。年龄4～53个月，平均（32±30）个月。体重3．0～14．5kg，平均（10±3）kg。术前经皮血氧饱和度0．58～0．88，平均0．69±0．16。结果 Ⅰ型5例，Ⅱ型4例，Ⅲ型5例。9例平行体外循环34～96min，平均（61±20）min。5例心停跳，主动脉阻断18～80min，平均（46±24）min；体外循环47～123min，平均（95±33）min。辅助呼吸19～74h，平均（31±17）h；住ICU2～8d，平均（4±2）d。术后24和48h时的心率与主动脉收缩压明显低于术后6h（P〈0．05）。术后6、24、48h的PaO2和SaO2无统计学差别。并发右侧胸腔积液、心包积液、再人手术室止血各1例。超声示右室流出道一肺动脉压差10～68mmHg（1mmHg=0．133kPa），平均（42±17）mmHg。结论 Gore-tex管道重建前向性肺循环，能很好地控制肺血流，术后血流动力学稳定。Objective To evaluate restoration of anterior pulmonary circulation with Gore-rex conduit in first-stage palliation of tetralogy of FaUot with pulmonary atresia. Methods 14 patients underwent operation. Themeanageofpatientswas（32±30）m（4～53m）. The mean body weight was （ 10 ± 3）kg（3.0 ± 14.5 kg）, SpO2 was 0.69 ± 0.16（0.58 ± 0.88）preoperatively. Results Type Ⅰ TOF was in 5 patients, type Ⅱ in 4 and type Ⅲ in 5. 9 patients received parallel cardiopulmonary bypass. The mean time of CPB was （61 ± 20）min （34±96 min）. 5 patients underwent surgery with heart arrest. The mean aortic clamp time was （46±24） min （18～80 min）, the mean cardiopulmonary bypass time was （95 ± 33） min （47 ～123） min. Postoperative ventilator time was （31 ± 17） h （ 19～74 h）. ICU stay （4 ± 2） d （2 ～8 d）. HR and AoSP at 24 h and 48 h were significantly lower than that at 6 h postoperatively （ P 〈 0.05）. There were no significant difference in PaO2 and SaO2 at 6 h, 24 h and 48 h postoperatively. One patient developed right pleural effusion and one patient had pericardial effusion. One patient was reoperated because of bleeding. ECHO showed mean gradient right venticle-pulmonary artery was （42 17） mmHg. （10 ～ 68 mmHg）. Conclusion Restoration of anterior pulmonary eire-lation with Gore-tex conduit can maintain pulmonary blood flow, stabilize hemodymincs.

关 键 词：法洛氏四联症 肺动瓣脉闭锁 心脏外科手术 人工血管 

分 类 号：R726.5[医药卫生—儿科]