动脉调转手术后中期生存结果及其影响因素分析  

Mid-Term Outcomes on Transposition of the Great Arteries Associated With Nonrestrictive Ventricular Septal Defect

作　　者：张雅娟[1] 胡盛寿[1] 李守军[1] 王旭[1] 郑哲[1] 李永青[1] 刘迎龙[1] 沈向东[1] 闫军[1] 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院小儿外科中心,北京市100037

出　　处：《中国循环杂志》2010年第3期215-218,共4页Chinese Circulation Journal

基　　金：国家科技支撑项目(2006BAI01A09)

摘　　要：目的:探讨完全型大动脉转位(TGA)合并室间隔缺损(VSD)及TGA型右心室双出口(Taussig-Bing)患者行动脉调转手术(ASO)后的中期生存结果及其影响因素。方法:回顾性研究2001-01-01至2007-12-31期间来我院行动脉调转手术并存活出院的115例TGA合并VSD及Taussig-Bing患者的临床资料,并对所有患者进行了电话随访及院内随诊复查。结果:115例存活患者均完成了随访,随访时间1～8年(平均3.1年)。其中10例患者随访过程中院外死亡(死亡率8.7%,10/115)。Kaplan-Meier法分析中期生存率6个月、1年、5年、8年分别为94.8%,92.2%,89.3%,89.3%。Cox回归分析显示手术年龄>3岁(相对危险度10.644,P=0.002)及术后1个月复查超声心动图,提示残存肺动脉高压(相对危险度4.864,P=0.047)是此类患者预后的重要影响因素。结论:TGA合并VSD及Taussig-Bing患者行动脉调转手术中期结果满意,死亡率及再手术率低。证实了手术年龄>6个月的TGA合并VSD及Taussig-Bing患者依然有手术适应证,但手术年龄>3岁者,术后1年死亡率高,故一定要做到定期随访,避免肺动脉高压危象发生。Objective ： To retrospectively study the potential risk factors influencing the mid-term outcomes after the arterial switch operation（ASO）for transposition of the great arteries （TGA）associated with nonrestrictive ventrieular septal defect（TGA/VSD）and TGA-type double-outlet fight ventricle （DORV）. Methods ：A total of 115 patients who successfully underwent ASO from January 2001 to December 2007 in our hospital were summarized. All patients finished the follow-up study with the average of 3 years（ 1-8 years）by both telephone visit and in-hospital check-up. Results ： 10 patients died during the follow-up period（8.7% , 10/115 ）. Kaplan-Meier calculation indieated that the survival rate for 6 months,1 year,5 years and 8 years after ASO were 94. 8% ,92. 2% ,89. 3% and 89. 3% respectively. Cox regression analysis revealed that patients age elder than 3 years at the operation （OR = 10. 644, P = 0. 002 ）and with the residual high pulmonary arterial pressure at 1 month after the surgery （ OR = 4. 864,P = 0. 047 ）were strongly correlated with the post-operational death. Conclusion：TGA/VSD and DORV could be treated＇by ASO, it had satisfied mid-term outcome with the low mortality rate. Patients elder than 6 months still had the operative indications. While patients elder than 3 years had the high risk for post operational death within 1 year. Periodic check-up was important to avoid high pulmonary arterial pressure.

关 键 词：死亡危险因素 室间隔缺损 完全型大动脉转位 Taussig—Bing畸形 生存率 

分 类 号：R541[医药卫生—心血管疾病]