大动脉调转手术35例分析  

EXPERIENCES ON ARTERIAL SWITCH OPERATION:REPORT OF 35 CASES

作　　者：陈凯明[1] 刘浪[1] 曹勇[1] 赖锋华[1] 胡楝[1] 朱伯卫[1] 林世廷[1] 王茂生[1] 

机构地区：[1]广东省高州市人民医院心血管外科,525200

出　　处：《中国煤炭工业医学杂志》2014年第6期909-912,共4页Chinese Journal of Coal Industry Medicine

基　　金：广东省茂名市科技计划项目(编号:20110804)

摘　　要：目的总结大动脉调转手术的外科技术和围术期处理的临床经验。方法 2006年1月—2014年1月,共接收大动脉转位患儿53例,18例因多种原因未进行手术治疗,35例接受大动脉调转手术。其中,男21例,女14例;合并室间隔缺损(TGA/VSD)的患儿27例,年龄14d^1岁;体重3.2~8.8kg,平均(5.27±1.56)kg;室间隔完整(TGA/IVS)的患儿8例,年龄为10d^1个月;体重为2.9~5.5kg,平均(3.46±1.15)kg。全部患儿均接受Ⅰ期大动脉调转手术,无快速Ⅱ期病例。术毕当天及出院前常规行心脏超声检查,并术后3个月、半年及每年行常规随访。结果术后早期死亡3例,病死率为8.6%。延迟关胸3例,分别为1d、2d和3d,无切口感染及愈合不良出现;再开胸止血3例,发生率为8.6%。27例TGA/VSD患儿的平均体外循环转流时间为(147±34)min,主动脉阻断时间为(116±29)min;术后呼吸机辅助时间为22~163h,ICU滞留时间为3~17d;出院前心脏超声提示1例患儿存在残余VSD,穿隔血流直径<2mm;未见心室壁反常运动;2例肺动脉血流速度稍增快,分别为2.0m/s及2.2m/s,另外2例肺动脉血流速度明显增快,分别达到3.1m/s及3.7m/s;3例主动脉血流速度超过2m/s,其中1例达到2.5m/s。心电图提示无患儿存在心肌梗死。8例TGA/IVS患儿的平均体外循环转流时间为(167±57)min,主动脉阻断时间为(135±49)min;术后呼吸机辅助时间为48~146h,ICU滞留时间为4~16d;出院前心脏超声提示2例肺动脉血流速度稍增快,达到2m/s,1例主动脉血流速度达到2.0m/s。心电图提示无患儿存在心肌梗死。结论大动脉调转术是治疗完全性大动脉转位的成熟术式,把握手术时机、适应证及加强围术期管理可以提高存活率。Objective To summarize the clinical experience of surgical technique and perioperative treatment of arterial switch operation. Methods Between January 2006 and January 2014, totally 35 newborns and infants With TGA/VSD and TGA/IVS underwent arterial switch operation, 21 boys and 14 girls. In the TGA/VSD group, there were 27 cases, ranging from 14 days to 1 year at surgeries, and weight from 3.2 -8.8kg with average of 5.27±1.56kg. In the TGA/IVS group, there were 8 cases, ranging from 10 days to 1 month at surgeries, and weight from 2.9-5.5kg with average of 3.46 ± 1.15kg. All patients underwent one stage of arterial switch operation. Routine follow- up checking points were set at discharging, 3 months, half a year and every year after operation. Results The early death rate was 8.6%（3/35）, and the fatality rate was 8.6% （3/35）. In the TGA/VSD group, average cardiopulmonary bypass time was 147 ± 34 minutes with the aortic crossclamp time was 116 ± 29 minutes ; Ventilator support time was 22-163 hours,and the length of ICU stay was 3-18 days;2 case had residual VSD with the diameter less than 2ram;The pulmonary flow velocity in 2 cases increased mildly to 2.0m/s and 2.2m/s,and another 2 cases increased severely to 3. 1m/s and 3.7m/s;The aortic flow velocity in 3 cases increased to 2.0m/s. ECG instructs no case had myocardial infarction signs. In the TGA/IVS group, average cardiopulmonary bypass time was 167 ± 57 minutes with the aortic crossclamp time was 135± 49 minutes; Ventilator support time was 48-146 hours, and the length of ICU stay was 4-16days;The pulmonary flow velocity in 2 cases increased mildly to 2.0m/s;The aortic flow velocity in 1 case increased to 2.0m/s. ECG instructs no case had myocardial infarction signs. Conclusions Arterial switch operation remains the mature choice for treating various forms of complete transposition of great arteries, to grasp the operation time, control the operation adaptation and perioperative management are the key points to improve the survival rate.

关 键 词：完全性大动脉转位 大动脉调转术 病死率 并发症 儿童 

分 类 号：R654[医药卫生—外科学]