6月龄以上患儿大动脉调转手术效果分析  

Arterial switch operation in children over 6 months

作　　者：王显悦[1] 毕生辉[1] 王晓武[1] 董文鹏[1] 徐宇[1] 梅鲁刚[1] 梁爱琼[1] 张卫达[1] 

机构地区：[1]广州军区总医院心脏外科中心,广州510010

出　　处：《临床心血管病杂志》2013年第6期455-458,共4页Journal of Clinical Cardiology

基　　金：广州市科技计划项目(No:2011J4100021);天普研究基金(No:01201122)

摘　　要：目的:观察6月龄以上患儿大动脉调转手术效果。方法:将2009-06-2012-07于我中心拟行大动脉调转手术的患儿按入院年龄分为两组:A组(<6个月,24例)和B组(≥6个月,18例)。观察两组手术效果,记录出院3个月随访心脏超声和并发症情况;比较两组患儿术中情况:手术时间、体外循环时间、心脏停搏时间和主动脉开放后心脏自动复跳情况;比较两组患儿循环功能指标:术中血液超滤完成后即时平均肺动脉压力(MPAP)、平均动脉压(MAP)、中心静脉压(CVP)和监护室内血管活性药物评分,观察手术前后患儿肺动脉压力改变情况;比较两组患儿监护室治疗情况:机械通气时间、监护室治疗时间、再次(多次)气管插管例数和肺部感染例数。结果:A组术后当日死亡2例,余临床治愈出院,其中12例术后3个月随访心脏超声提示心内畸形矫治良好,无并发症发生;B组院内猝死1例,余临床治愈出院,术后3个月随访8例,7例心脏超声提示心内畸形矫治良好,无并发症发生,院外猝死1例。两组患儿手术时间、体外循环时间、心脏停搏时间、自动复跳例数及术中血液超滤完成即时MAP等均差异无统计学意义。与A组比较,B组患儿术中血液超滤完成即时MPAP和CVP、监护室内血管活性药物评分、术后机械通气和监护室滞留时间、再次气管插管及肺部感染发生例数等均升高(均P<0.05);两组患儿术后MPAP均较术前明显下降(均P<0.05)。结论:6月龄以上患儿大动脉调转术术后并发症多,恢复慢且不平稳,有发生猝死的可能。Objective：To investigate effects of arterial switch operation （ASO）in children over 6 months. Method：From June 2009to July 2012,children scheduled for ASO were divided into A group（6months,n= 24）and B group （≥6 months,n=18）,and ASO performed after preoperative treatments and examinations. Effects of ASO,3months follow up echocardiography and complications were observed.The records about ASO from two groups were compared in terms of operating time,cardiopulmonary bypass time,cardiac arrest time and automatic cardioversion in operation.Circulation function records from two groups such as mean pulmonary artery pressure（MPAP）,mean arterial pressure（MAP）and central venous pressure（CVP）right after blood ultrafiltra- tion,inotropic scores at ICU were made contrasts.The change of MPAP before and after operation in two groups were observed.The records in ICU were compared included ICU time,ventilation time,frequency of re-intubation and pulmonary infection.Result：Two infants died in the first day after operation in group A,the others were clini- cally cured,and 12cases had contented follow-up echocardiography examinations 3months later and had no com- plications.Sudden death accurred to 1case in group B in hospital,other children were clinically cured,7cases had satisfactory echocardiography and complications follow-up 3 months later,and 1case suffered sudden death at home.There was no statistical difference between two groups as to operating time,cardiopulmonary bypass time, cardiac arrest time and automatic cardioversion in operation.MAP in two groups right after blood ultrafiltration in operation had no statistical difference.MPAP in two groups descended obviously after operation （P〈0.05）. Compared with group A,children in group B had higher MPAP,CVP right separation from modified ultrafiltra- tion,higher inotropic scores at ICU,longer ICU time and ventilation time,higher frequency of re-intubation and pulmonary infection postoperation（all P〈0.05）.Conclusion：ASO in children

关 键 词：大动脉调转术 小儿 猝死 

分 类 号：R614[医药卫生—麻醉学]