应用同种带瓣管道重建右室流出道的危险因素分析  

Risk Factors of Using Valved Homograft Conduit for Right Ventricular Outflow Tract Reconstruction

作　　者：董自超[1] 汪曾炜[2] 王辉山[2] 尹宗涛[2] 

机构地区：[1]第四军医大学西京医院,陕西西安710032 [2]沈阳军区总医院,辽宁沈阳110016

出　　处：《现代生物医学进展》2011年第10期1891-1895,1986,共6页Progress in Modern Biomedicine

摘　　要：目的:评价采用同种带瓣管道行右室流出道重建术的临床效果,探讨影响手术效果及临床预后的因素。方法:回顾2002年11月至2010年11月期间应用同种带瓣管道行右室流出道重建患者的临床资料,分析患者手术前后的一般信息、血流动力学表现与临床预后的关系。结果:行右室流出道重建术后49例痊愈出院,5例死亡,存活率90.7%,死亡率9.3%。手术前后比较右室流出道内径较术前明显增加,右室-左室收缩压比值、右室-肺动脉压差较术前明显降低,三尖瓣反流、肺动脉瓣反流较术前加重,肺动脉瓣狭窄较术前减轻。统计分析表明患者死亡的危险因素有术后右室平均压、术后肺动脉-主动脉收缩压比值、术后二尖瓣反流。术后心胸比、术后肺动脉收缩压、术后肺动脉-主动脉收缩压比值、术后三尖瓣反流可能和术后患者ICU时间延长有关。McGoon指数、术后心胸比、术后肺动脉收缩压、术后右室平均压、术后肺动脉-主动脉收缩压比值、合并动脉导管未闭、术后三尖瓣反流可能和术后患者呼吸机时间延长有关。结论:复杂先天性心脏病患者采用同种带瓣管道重建右室流出道可以取得较满意的临床效果,术后流出道梗阻矫正满意,可以防止肺动脉返流导致的心脏损害。To investigate the effect of right ventricular outflow tract reconstruction by homografts. Methods： Patients who underwent valved homograft conduit reconstruction of the right ventricular outflow tract in our institution, between November 2002 and November 2010, were retrospectively reviewed. Results： Total hospital mortality was 9.3 % （5 of 54）. The diameter of right ventricular outflow tract, tricuspid regurgitation and pulmonary regurgitation increased after operation. The ratio of the systolic pressure between right and left ventricle, the pressure gradient between right ventricle and pulmonary and pulmonary stenosis decreased. Analysis show that the mean pressure of the right ventricle, ratio of systolic pressure between pulmonary and aorta after operation and mitral regurgitation may be risk factors for patient mortality. The cardiothoracic ratio, systolic pressure of pulmonary, ratio of systolic pressure between pulmonary and aorta and tricuspid regurgitation after operation maybe indicate longer ICU stays. The McQoon Index and exist of patent ductus arteriosus before operation and postoperative eardiothoracic ratio, systolic pressure of pulmonary, mean pressure of the right ventricle, ratio of systolic pressure between pulmonary and aorta and tricuspid regurgitation may predict longer mechanical ventilation. Conclusion： These results indicate that homografls show excellent outcomes in right ventricular outflow tract reconstruction.

关 键 词：先天性心脏病:同种:带瓣管道:右室流出道重建 

分 类 号：R654.2[医药卫生—外科学]