完全性大动脉转位矫治手术的围术期处理  

Anesthetic Management for Corrective Repair of Complete Transposition of Great Arteries

作　　者：晏馥霞[1] 王宇红[1] 王嵘[1] 常勇男[1] 王伟鹏[1] 林霖[1] 李立环[1] 

机构地区：[1]中国医学科学院阜外心血管病医院麻醉科,北京100037

出　　处：《实用儿科临床杂志》2009年第12期951-953,961,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的总结完全性大动脉转位(TGA)矫治手术的围术期处理措施及影响预后的因素。方法2004年1月-2008年12月行TGA外科矫治术患儿230例(年龄<7岁)。根据临床诊断分组:Ⅰ组为室间隔完整的TGA(TGA/IVS,n=73),Ⅱ组为伴室间隔缺损(VSD)的TGA(TGA/VSD,n=118),Ⅲ组为伴左室流出道狭窄的TGA(TGA/LVOTO,n=39)。Ⅰ组和Ⅱ组患儿行大动脉调转术(ASO);Ⅲ组患儿行Rastelli手术、改良REV手术和改良Nikaidoh手术。结果230例患儿中位数年龄为0.3岁(1d～7岁);中位数体质量为5.0kg(2.4～23.0kg)。Ⅲ组体外循环和主动脉阻断时间中位数分别为279min(100～501min)和191min(80～281min),为3组中最长。3组共死亡22例(9.6%)。其中Ⅰ组死亡10例(13.7%),2例术前有严重代谢性酸中毒,未行球囊房间隔扩张术,急诊ASO手术后死于低心排出量;3例发生急性左心衰竭死亡;余5例死亡与伴心血管畸形有关。Ⅱ组死亡9例(7.6%),3例突发心律失常死亡;3例二次气管插管后并肺部感染死亡;1例并主动脉弓缩窄,同期手术矫治,手术后发生脑部并发症死亡;2例左心功能训练手术后肺功能较差,急诊行ASO手术后死亡。Ⅲ组死亡3例(7.5%),其年龄均小于本组中位数年龄,死亡原因为手术后长时间低心排出量。16例伴冠状动脉异常,其中8例术后死亡。结论TGA/IVS患儿手术前球囊房间隔扩张处理并严重酸中毒患儿,明显影响手术结果,体外循环后注意左心功能的维护。TGA/VSD患儿突发心律失常和术后肺内感染是主要死亡原因。TGA/LVOTO患儿手术时间长,低龄患儿手术死亡危险增加。TGA患儿伴冠状动脉异常病死率增加。Objective To summarize clinical management for corrective operation of complete transposition of great arteries and the influence factors on its. Methods Two hundred and thirty patients （ age 〈 7 years） with complete transposition of great arteries （TGA） who underwent corrective operation from Jan. 2004 to Dee. 2008 were reviewed. They were divided into 3 groups according to their clinical diagnosis： group Ⅰ （n =73） included TGA with intact ventricular septum （TGA/IVS）, group Ⅱ （n = 118） included TGA with ventricular septal defect （TGA/VSD）, and group Ⅲ（ n = 39） included TGA with left ventricular outflow tract obstruction （TGA/LVOTO）. The patients in group Ⅰ and group Ⅱ underwent arterial switch operation （ASO）, and the patients in group Ⅲ received Rastelli procedure, modified REV procedure or modified Nikaidoh procedure. Results The median age was 0.3 years （ ranging from 1 day to 7 years） and median body weight was 5.0 kg（ ranging from 2.4 to 23.0 kg） in all patients. The median cardiopulmonary bypass （ CPB ） time （ 279 min, ranging from 100 to 501 min） and the cross -clamp time（191 rain,ranging from 80 to 281 min） in Group Ⅲ were the longest in the 3 groups. There were 22 （9.6%） perioperative deaths of all patients. Ten cases deaths in group I （ 13.7% ） , 9 cases in group Ⅱ （7.6%）and 3 cases in group （7.6%）. In group Ⅰ , there were 2 patients with preoperative severe metabolic acidosis, without balloon atrial septostomy before emergent ASO procedure, and died from low cardiac output after operation. Three patients died from acute left heart failure. The other 5 deaths were related to cardiovascular lesions. In group Ⅱ , 3 patients died from arrhythmia, 3 patients died from lung infection after reintubation, 1 patient with coarctation of the aorta died from brain problem, and 2 patients died from lung infection following emergent ASO operation after left ventricular training. In Group Ⅲ, 3 patients, below the media

关 键 词：完全性大动脉转位 大动脉调转术 改良Nikaidoh手术 体外循环 

分 类 号：R726.5[医药卫生—儿科]