姑息性右心室-肺动脉连接术中管道材料及型号的选择与应用  

Choice of Conduit Size and Material for Palliative Right Ventricle-to-Pulmonary Artery Shunt

作　　者：李坤[1] 李守军[1] 公兵[1] 杨克明[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院小儿外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2013年第6期632-636,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 评价不同管道材料（Gore-Tex人工血管、牛颈静脉和自体心包管道）在姑息性右心室-肺动脉连接术中的应用效果，探讨患者适用的管道型号与体重、McGoon比之间的相关性。 方法 回顾性分析 2010年7月至2012年7月北京阜外心血管病医院小儿外科中心24例先天性心脏病患者接受姑息性右心室-肺动脉连接术治疗的临床资料，其中男11例，女13例；年龄60 d至6岁；体重（10.22±7.41） kg。肺动脉闭锁合并室间隔缺损（PAVSD） 22例，法洛四联症（TOF） 1例，右心室双出口（DORV） 1例。使用的外管道材料分别为自体心包17例，Gore-Tex人工血管5例，牛颈静脉2例。对重建管道的直径与患儿体重进行线性回归分析，以McGoon比为参数对公式再作矫正。 结果 无围术期死亡，术后全组患儿血氧饱和度较术前增加20.37%±28.33%。心电图均显示窦性心律，心功能（NYHA） Ⅱ级23例，Ⅲ级1例。采用自体心包手术患儿术后呼吸机使用时间短于其它两种材料（P=0.017）。术后随访16例，随访时间10个月～2年。其中采用自体心包手术患儿完成随访12例，采用Gore-Tex人工血管手术3例，采用牛颈静脉手术1例。随访期间采用自体心包手术患儿McGoon比为1.98±0.46，Gore-Tex人工血管手术为1.83±0.33，牛颈静脉手术为1.68，均较术前有明显增加（P＜0.05）。完成根治6例（其中采用自体心包手术患儿完成根治手术5例，采用Gore-Tex人工血管手术患儿完成根治手术1例）。随访过程中未发现明显与手术相关的并发症发生。通过线性回归分析，得出合适的管道型号与患者体重关系的公式：管道直径（mm） =0.327×体重（kg）＋4.599。通过McGoon比、管道型号及公式计算值的对比分析发现：McGoon比＜0.8，可取大于计算值的第一个整数；McGoon比＞1.2，则可取小于计算值的第一个整数。0.8＜McGoon比＜1.2，则前后两个Objective To assess clinical results of three different conduit materials （Gore-Tex synthetic graft，bovinejugular vein and autologous pericardium）for palliative right ventricle-to-pulmonary artery （RV-PA） shunt，and explore the correlation between suitable conduit size and patients’ body weight and McGoon ratio. Methods We retrospectively analyzed clinical data of 24 patients with congenital heart diseases who underwent palliative RV-PA shunt in Department of Pediatric Cardiovascular Surgery of Fu Wai Cardiovascular Hospital from July 2010 to July 2012. There were 11 males and 13 females with their age ranging from 60 days to 6 years and body weight of 10.22±7.41 kg. There were 22 patients with pulmonary atresia and ventricular septal defect （PAVSD），1 patient with tetralogy of Fallot （TOF） and 1 patient with doubleoutlet right ventricle （DORV）. Among different conduit materials，autologous pericardium was used for 17 patients，Gore-Texsynthetic graft was used for 5 patients，and bovine jugular vein was used for 2 patients. Conduit size and children’s body weight were analyzed with linear regression，then the equation was corrected with McGoon ratio. Results There was no perioperative death. Postoperative percutaneous saturation （SpO2）of the 24 children was 20.37%±28.33% higher than preoperative SpO2 . Electrocardiogram showed sinus rhythm in all the patients. Twenty-three patients were NYHA classⅡ，and 1 patient was NYHA classⅢ. Postoperative mechanical ventilation time of patients with autologous pericardium were significantly shorter than those of patients with other 2 materials （P=0.017）. Sixteen patients were followed up from 10 months to 2 years after discharge，including 12 patients with autologous pericardium，3 patients with Gore-Tex synthetic graft and 1 patient with bovine jugular vein. During follow-up，McGoon ratio of patients with autologous pericardium，Gore-Tex synthetic graft and bovine jugular vein were 1.98±0.46，1.83±0.33 and 1.68 respectiv

关 键 词：右心室-肺动脉连接 自体心包 Gore-Tex人工血管 牛颈静脉 管道型号 

分 类 号：R654.2[医药卫生—外科学]