完全性大动脉转位合并室间隔缺损、肺动脉狭窄患者行Rastelli术后早期处理(附2例报告)  

Early Management of Patients Having Complete Transposition of Great Artery Combined with Ventricular Septal Defect and Pulmonary Stenosis After Rastelli Operation

作　　者：王旭东[1] 周中新[2] 黄继江[2] 李明[1] 胡恒诺[1] 

机构地区：[1]徐州医学院第二附属医院ICU,江苏徐州221006 [2]徐州医学院第二附属医院心胸外科,江苏徐州221006

出　　处：《华西医学》2008年第2期223-224,共2页West China Medical Journal

摘　　要：目的：总结Rastelli术治疗合并心室间隔缺损和肺动脉狭窄的完全性大动脉转位术后早期处理经验。方法：2例完全性大动脉转位合并心室间隔缺损和肺动脉狭窄,年龄15岁和17岁。2例均在中低温（22℃～25℃）、低流量体外循环下,应用Rastelli术对其进行解剖矫正。术后严密监测血流动力学指标,及时补充胶体溶液,维持适当的过度通气,应用正性肌力药物及降低肺血管阻力药物。结果：术后无死亡。术后早期并发症包括1例发生低心排血量综合征,房性心动过速1例,低氧血症1例,二次开胸止血1例。结论：术后维持足量的前负荷,充分镇静镇痛,降低氧耗,有效降低肺循环阻力,及时纠正低心排血量综合征、低氧血症、心律失常等并发症,可有效提高手术成功率。Objective：To review the experiences of perioperative management of petient having complete transposition of great artery combined with Ventricular Septal Defect and Pulmonary Stenosis after Restelli.Methods：There were 2 patients with transposition of great arterie with ventricular septal defect and pulmonary stenosis.Aged 15 years and 17 years.Received Rastelli operation.The operation was carried out under mid-hypothermia circulator arrest and low-flow perfusion.Colloid fluid was infused immediately after operation.Proper respiratory alkalosis was maintained.Inotropic support and drug decreas-ing pulmonary resistance were used.Results：There was no operative morlality.The main complications were low cardiac output syndrome,atrial tachycardia,hypoxemia and hemostasis.Conclusion：To improve the operative results,enough preload should be maintained,appropriate mitigate and analgesia,low oxo-fade as well as low pulmonary resistance should be maintained postoperatively.Low cardiac output syndrome,tachycardia and hypoxemia should be treated in time.Early treatment might effectively assure the successes of the operations.

关 键 词：心脏缺损 先天性 完全性大动脉转位 RASTELLI术 手术后并发症 

分 类 号：R654.2[医药卫生—外科学]