左室训练术在婴幼儿大动脉转位分期手术中的应用  

Staged Left Ventricular Retraining for Infants with Transposition of the Great Arteries

作　　者：姜睿[1] 闫军[1] 李守军[1] 吴永波[1] 王强[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,北京100037

出　　处：《中国胸心血管外科临床杂志》2014年第6期779-782,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结左室训练术在婴幼儿大动脉转位分期手术中的经验。方法2001年1月至2011年12月北京阜外心血管病医院对38例室间隔完整的大动脉转位及合并限制性小室间隔缺损的大动脉转位患儿施行了左室训练手术，其中男26例、女12例，年龄（19．1±7．7）个月，体重（7．6±4．7）埏。术前动脉血氧饱和度72．6％±9．1％。左室训练术包括体动脉肺动脉分流术和肺动脉环缩术。3例需要同期行房间隔开窗术。术后对患儿进行随访观察。结果本组患儿术后动脉血氧饱和度从术前72．6％4±9．1％上升至83．9％±8．1％，左右心室压力比从术前的0．364±O．04上升至0．75±0．09。全组死亡3例，死亡率7．89％。随访35例，随访时间2～11年，随访期间行二期动脉调转手术23例。结论对于超过新生儿期已经发生左心室退化的大动脉转位患儿，左室训练术可以安全有效的施行，为二期做动脉调转手术提供必要的条件。Objective To summarize clinical experience of staged left ventricular retraining for infants with transposition of the great arteries(TGA). Methods From January 2001 to December 2011,38 TGA infants with intact ventricular septum or a small ventricular septal defect underwent left ventricular retraining in Fu Wai Hospital. There were 26 male and 12 female patients with their age of 19.1±7.7 months and body weight of 7.6±4.7 kg. Preoperative arterial oxygen saturation(Sa O2) was 72.6%±9.1%. Left ventricular retraining included aortopulmonary shunt and pulmonary artery banding. Three patients received concomitant excision of the atrial septum. All survival patients were followed up after discharge. Results Postoperatively,Sa O2 increased to 83.9%±8.1% from preoperative 72.6%±9.1%, and left ventricle-to-right ventricle pressure ratio increased to 0.75±0.09 from preoperative 0.36±0.04. Three patients(7.89%)died postoperatively. Thirty-five patients were followed up for 2 to 11 years. During follow-up, 23 patients successfully received second stage arterial switch operation(ASO). Conclusion For TGA infants with decreased left ventricular mass who have missed the neonate period,left ventricular retraining is a safe and efficacious procedure to provide necessary preparation for second stage ASO.

关 键 词：左室训练术 大动脉转位 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]