发绀型复杂先天性心脏病患儿姑息术后血气与血流动力学变化研究  

Change of blood gas and hemodynamic parameters after palliative procedure in pediatric patients with complex cyanotic congenital heart disease

作　　者：樊星[1,2] 张宏家[1,2] 刘迎龙[1,2] 范祥明[1,2] 贺彦[1,2] 朱耀斌[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所胸心外科,北京100029

出　　处：《中华实用诊断与治疗杂志》2014年第4期342-345,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：首都医科大学基础-临床科研合作基金项目(13JL26;11JL50);国家自然科学基金(81371443);国家自然科学基金(30471721);国家自然科学基金(30670928);国家自然科学基金(81070055);科研基础-科技创新平台项目(PXM2011_014226_07_000060);北京市自然科学基金(7112046);北京市自然科学基金(7122056);北京市医药产品和技术重大项目培育研究项目(Z101107050210020);北京市科委首都市民健康项目(Z111100074911001);北京市卫生系统高层次卫生技术人才培养项目(领军人才2011-1-4)

摘　　要：目的比较发绀型复杂先天性心脏病患儿接受复合姑息手术（体肺分流术即改良BT＋双向腔肺吻合术即双向Glenn）或单一姑息手术（双向腔肺吻合术）术后血气及血流动力学指标变化，探讨2种术式在改善患儿发绀方面的影响。方法45例发绀型复杂先天性心脏病患儿根据手术方式不同分为复合姑息手术组（改良BT术＋双向Glenn术）20例和单一姑息手术组（双向Glenn术）25例；比较2组术后血气及血流动力学指标变化。结果单一姑息组监护室停留时间、呼吸机使用时间（（29．6±10．8）、（8．7±1．5）h）明显低于复合姑息组（（86．3±24．1）、（29．5±9．4）h）（P〈O．05）；复合姑息组术后出现乳糜胸1例，单一姑息组出现胸腔积液1例，均经保守治疗后痊愈；随访2～24个月，2组各完成根治手术1例，单一姑息组1例远期死亡；2组患儿术后血红蛋白、红细胞压积及脉搏血氧饱和度均较术前明显改善（P〈0．05），2组间比较差异无统计学意义（P〉0．05）；复合姑息组拔除气管插管前连续5次血气分析中pa（O2）、动脉血氧饱和度（arterialoxygensaturation，SaO2）均高于单一姑息组（P〈O．05），pa（CO2）、pH值、乳酸、中心静脉压与单一姑息组比较差异无统计学意义（P〉0．05）；2组拔除气管插管后连续5次血气分析中，pa（CO2）、pH值、乳酸、中心静脉压、pa（O2）、SaOz比较差异均无统计学意义（P〉O．05）。结论复合姑息手术与单一姑息手术均可明显改善患儿发绀及血流动力学，可根据患儿自身肺动脉发育情况选择手术方案，在拔除气管插管后恢复过程中2种手术方案均可达到同等较理想效果。Objective To evaluate the improvement of cyanosis by comparing the changes of blood gas and hemodynamic parameters after modified Blalock-Taussig @ bidirectional cavopulmonary shunt （MBTS-c-BDCPS） or only BDCPS in patients with complex cyanotic congenital heart disease. Methods Forty-five patients with complex cyanotic congenital heart disease were divided into two groups according to the different surgical procedures： MBTS--BDCPS group （n= 20） and BDCPS group （n = 25）. The change of blood gas and hemodynamic parameters after operation were compared between two groups. Results The ventilatory time and ICU stay were （8.7 ± 1.5） and （29.6 ± 10.8） hours in BDCPS group, significantly lower than those in MBTS--BDCPS group （（29. 5±9.4） and （86. 3±24. 1） hours） （P〈0.05）. Chylothorax occurred in one patient in MBTS--BDCPS group and pleural effusion in one patient in BDCPS group, and both patients were cured and discharged after conservative treatment. All patients were followed up for 2 to 24 months. Two patients were performed radical surgery and cured in two groups, and there was one late death in BDCPS group. The levels of hemoglobin, hematocrit and arterial oxygen saturation （SaO2） were improved after operation in comparison with before operation （P〈0. 05）, but there were no significant differences between two groups （P〈0. 05）. The levels of pa（O2 ） and SaO2 detected for five times before extubation were higher in MBTS--BDCPS group than those BDCPS group （P〈0.05）, and there were no significant differences in pa（CO2 ）, pH, lactic acid and vena cava pressure between two groups （P〈0.05）. There were no significant differences in pa（CO2）, p H, lactic acid, vena cava pressure, pa（O2 ） and SaO2 detected for five times after extubation between two groups （P〉 0.05）. Conclusions Both MBTS-t-BDCPS andBDCPS can improve cyanosis and hemodynamic parameters in pediatric patients with complex congenital heart disease. The final choice of pr

关 键 词：发绀型复杂先天性心脏病 体肺分流术 双向腔肺吻合术 血流动力学 

分 类 号：R725.4[医药卫生—儿科]