小于6个月婴儿完全性肺静脉异位引流的围手术期监护  

Perioperative care of total anomalous pulmonary venous connection in newborns and babies within 6 months

作　　者：束亚琴[1] 彭卫[1] 戚继荣[1] 孙剑[1] 莫绪明[1] 

机构地区：[1]南京医科大学附属南京儿童医院心胸外科江苏省小儿先天性心脏病中心,210008

出　　处：《中华胸心血管外科杂志》2014年第3期156-159,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金（81070137）;国家“十二五”科技支撑计划（2011BAI11B22）

摘　　要：目的 总结92例6月龄以内完全性肺静脉异位引流（TAPVC）患婴的手术疗效及围手术期监护.方法 2001年9月至2013年5月,92例患婴接受TAPVC矫治手术,其中心上型48例,心内型36例,心下型6例,混合型2例,其中新生儿36例.所有患婴均在中低温或深低温体外循环（CPB）下行TAPVC矫治术.患婴术前均经超声心动图、CT扫描以及术中解剖明确病理诊断.根据患婴TAPVC类型和解剖特点选择手术方法,术后入ICU.术后呼吸机辅助呼吸,小剂量、多种正性肌力药维持心功能,预防肺动脉高压危象.结果 术后24 h内8例死于严重低心排血量综合征,84例术后恢复顺利.生存患婴均术后随访1个月～12年,3例术后肺静脉狭窄（PPVS）,81例心功能恢复良好.结论 完全性肺静脉异位引流一经确诊应尽快手术治疗,效果满意,围手术期监护的关键在于左心功能维护、液体负平衡的保证和肺高压预防处理.Objective To summarize perioperative care and effect of surgical treatment of total anomalous pulmonary venous connection （TAPVC） in newborns and babies within 6 months.Methods From September 2001 to May 2013,ninetytwo consecutive patients with TAPVC received surgical correction under cardiopulmonary bypass （CPB） with moderate or deep hypothermia.The anatomic subtype included supracardiac type 48,intracardiac type 36,infracardiac type 6 and mixed type 2.There were 36 newboms.Pathological diagnosis was made by echocardiogram,computerized tomography and operative findings during operation.The option of procedure was determined by findings.Respirator assisted breathing after operation and cardiac function was maintained by a variety of positive inotropic drugs,to prevent the happening of the pulmonary hypertension crisis.Results Severely low cardiac output syndrome occurred in 8 patients and they died within 24 hours after operation.The remaining cases postoperative recover smoothly and receive postoperative follow-up about 1 month to 12 years,3 cases of postoperative pulmonary vein stenosis （PPVS） occurred.Conclusion Total anomalous pulmonary venous connection should be surgical treatment as soon as possible with satisfied effect.The key of perioperative care is maintenance of left heart function,negative balance of liquid,prevention and treatment of pulmonary hypertension.

关 键 词：心脏缺损 先天性 肺静脉异位引流 心脏外科手术 围手术期监护 

分 类 号：R726.5[医药卫生—儿科]