非体外循环下双向格林分流术治疗复杂先天性心脏病的临床分析  

Bidirectional Glenn Shunt without Cardiopulmonary Bypass in Treatment of Complex Congenital Heart Disease

作　　者：高开柱 肖明第 陈小中 王宜青 王吉祥 肖亦敏 李小波 程云阁 

机构地区：[1]上海远大心胸医院成人心脏中心,上海200235

出　　处：《华中科技大学学报（医学版）》2013年第6期721-723,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的观察非体外循环下双向格林分流术治疗复杂先天性心脏病的疗效。方法 2009年3月~2011年11月间42例确诊为复杂先天性心脏病、术前影像学资料证实不能行一期解剖矫治或生理矫治手术的患者,采用非体外循环下双向格林分流术进行治疗,总结治疗效果。并与2008年5月~2009年8月间在体外循环下实施的12例双向格林分流术患者资料进行比较。结果非体外循环组除1例患者自动出院以外,其余患者均康复出院。术中患者平均自体转流时间为（36.4±15.2）min,术前血氧饱和度为（65.6±8.7）%,术后早期血氧饱和度为（86.7±9.1）%,术后3个月血氧饱和度为（89.5±8.9）%,平均呼吸机辅助时间为（14.2±4.6）h;康复者血氧饱和度明显上升,活动耐受量及心功能显著改善。结论非体外循环下双向格林分流术是一种安全的治疗复杂先天性心脏病的手术方式,临床效果优于体外循环下手术。术前选择合适的手术适应证、术中进行通畅的腔静脉-肺动脉吻合、术后正确的处理是确保手术成功的关键。Objective To observe the efficacy of bidirectional Glenn shunt without cardiopulmonary bypass in the treatment of complex congenital heart disease.Methods Forty-two patients who were diagnosed as having complex congenital heart disease between March 2009 and November 2011 were enrolled in the study.They were not eligible for one-stage anatomic correction operation or physiological correction operation according to the imaging data before operation.Bidirectional Glenn shunt without cardiopulmonary bypass was performed in these patients.Another 12 patients who received bidirectional Glenn shunt in the presence of cardiopulmonary bypass served as control.Results One patient left the hospital of his own accord.The others recovered smoothly.The mean self bypass time was（36.4±15.2）min.The mean blood oxygen saturation before operation was（65.6±8.7）%.It turned to（86.7±9.1）%in the early stage after operation,and was（89.5±8.9）% 3months after operation.The mean mechanical ventilation time was（14.2±4.6）h.In the recovered patients,the saturation of blood oxygen was obviously increased.Their heart function and action tolerance improved significantly.Conclusion The bidirectional Glenn shunt without cardiopulmonary bypass is a safe procedure in the management of patients with complex congenital heart disease.The clinical effect is better than that with cardiopulmonary bypass.Proper clinical indications,smooth anastomosis of the vena cava to the pulmonary artery and proper postoperative treatment are the key to successful surgery.

关 键 词：非体外循环 双向格林分流术 复杂先天性心脏病 

分 类 号：R654.2[医药卫生—外科学]