延迟关胸在小儿心脏外科应用的经验  

Experience of Delayed Sternal Closure Following Pediatric Cardiac Operation

作　　者：张玉龙[1] 李仲智[1] 李晓峰[1] 郭志和[1] 高国庆[1] 陆进[1] 柏松[1] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心,北京100045

出　　处：《中国体外循环杂志》2007年第1期20-22,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 回顾性总结延迟关胸在小儿心外科应用的经验.方法 研究2004年1月至2006年4月小儿低温体外循环心脏手术631例临床资料.其中23例（男15例,女8例）延迟关胸.年龄0.3～84（6.37±3.45）月,体重2.2～17.5（5.33±3.17）kg.完全性大动脉转位6例,法洛四联症6例,完全性肺静脉异位引流4例,室间隔缺损3例,完全性房室间隔缺损2例,室间隔完整型肺动脉闭锁1例,三尖瓣闭锁肺动脉环缩术后1例.结果 围术期死亡4例,死亡率17.39%,4例死亡原因为多脏器功能衰竭,其体外循环时间（166.50±60.30）min,阻断时间（96.54±52.61）min,与同期其他手术转机时间（66.76±32.71）min和阻断时间（46.49±23.86）min比较有统计学意义（P＜0.05）.19例因心脏功能差或压塞症状,其中5例同时合并心律失常并安放起搏导线,2例因出血,1例因肺功能差,1例为心外管道受压回ICU后床旁开胸.4例急性肾功能衰竭,其中1例合并脑梗塞,19例低心排综合征.除死亡4例外,余患儿皆痊愈出院.存活者无刀口及纵隔感染.结论 新生儿、小的婴幼儿、低体重及长时间体外循环与延迟关胸直接相关.小儿开胸心脏手术后出现的血液动力学不稳定、低心排、出血、心律失常及心外支持系统的应用,延迟关胸是一种渡过严重术后并发症的简单、安全而有效的解决方法.OBJECTIVE To review retrospectively the experience of delayed sternal closure following pediatric cardiac operation. METHODS Between January 2004 and April 2006, 631 pediatric cardiac patients underwent pediatric extracorpereal cireulation（ECC） operation. 23 patients underwent delayed sternal closure（DSC）. There were 15 males and 8 females with mean age of （6.37 ± 3.45 ） months （ from 0.3 to 84 months） and mean weight of （5.33 ± 3.17 ） kg （ from 2.2 to 17.5 kg）. Diagnoses included transposition of the great artery（6）, tetralogy of Fallot（6）, total anomalous pulmo- nary venous connection（4）, ventricular septul defect（3）, complete atrioventricular septul defects （2）, pulmonary atresia with intact septum（ 1 ） and tricuspid atresia post - banding procedure （ 1 ）. RESULTS There were 4 deaths （ 17.39% ）. Causes of death were multiorgan failure. ECC time were （ 166.50 ± 60.30） minutes verus （66.76 ± 32.71 ） minutes, aortic clamping time were （ 96.54 ± 52.61 ） minutes verus （ 46.49 ± 23.86） minutes in DSC group and non - DSC group. There were statistic significance （ P 〈 0.05 ）. The indication of DSC were as followed： cardiac compression or myocardium edema in 19 cases, among of them 5 patients associated with arryhythmias setting pacing -wires, uncontrollable hemorothage in 2 cases, pulmonary function depressed in 1 case, extracardiac conduit compression in 1 patient. The postoperative complications were： acute renal failure in 4 cases, encephalon infarction in 1 case, low cardiac output syndrome in 19 patients, all survivors had not incision or mediastinum infections. CONCLUSION The neonate, younger infant, lower body weight and longer ECC time are correlated with delayed sternal closure. The technique of delayed sternal closure is a simple, safe and very useful technique. It may help to overcome the problems such as unstable hemodynamic conditions, low cardiac output syndrome, hemorrhage, dysrhythmias and access for external cardia

关 键 词：延迟关胸 体外循环 小儿 手术 

分 类 号：R726.5[医药卫生—儿科]