完全性肺静脉异位引流合并左心室发育不全矫治手术中房间隔留窗的应用  

The effect of keeping atrial septal fenestration in correction of total anomalous pulmonary venous connection with left ventricular hypoplasia

作　　者：袁源[1] 鲍春荣[1] 丁芳宝[1] 马南[1] 沈赛娥[2] 梅举[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,200092 [2]上海交通大学医学院附属新华医院麻醉科,200092

出　　处：《中华胸心血管外科杂志》2015年第3期134-137,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委资助项目（13XD1403200）

摘　　要：目的 回顾性分析房间隔留窗对完全性肺静脉异位引流（TAPVC）合并左心室发育不全患儿术后疗效的影响.方法 收集2006年6月至2013年6月44例TAPVC合并左心室发育不全患儿资料.根据矫治手术中是否完全关闭房间隔缺损或卵圆孔,分为房间隔留窗组（A组,25例）和未留窗组（B组,19例）,研究房间隔留窗对TAPVC合并左心室发育不全矫治术早、中期结果的影响.结果 两组患儿年龄、体质量及左心室发育情况差异无统计学意义（P＞0.05）,A、B两组主动脉阻断时间差异无统计学意义（P＞0.05）,A组术中体外循环时间、术后呼吸机支持时间、正性肌力药物支持时间及ICU治疗时间均显著小于B组（P＜0.05）.术后低心排血量综合征A组4例（16.00％）,B组6例（31.58％）;术后肺水肿A组1例（4.00％）,B组2例（10.53％）,组间差异均无统计学意义（P＞0.05）.死亡3例（6.82％）,A、B组各1例死于严重低心排血量综合征,B组另有1例死于严重感染及多脏器功能衰竭.术后随访结果提示部分患儿房间隔分流可功能性自愈,术后1年患儿左心室发育基本达到正常水平.结论 手术矫治TAPVC合并左心室发育不全患儿时,术中房间隔留窗可作为促进患儿术后恢复的治疗策略.Objective To evaluate the effect of keeping atrial septal fenestration in correction of total anomalous pulmonary venous connection （TAPVC） with left ventricular hypoplasia.Methods We reviewed 44 TAPVC patients between June,2006 and June,2013 in Shanghai Xinhua Hospital.According to whether keeping atrial septal fenestration during operation,patients were divided into group A（keeping fenestration,25 cases） and group B（no fenestration,19 cases）.Retrospective statistical analysis was carried on the in-patient data and follow-up outcomes.Results No statistically significant differences between the two group on age,weight,left ventricular volume and crossclamp time （P ＞ 0.05）.While cardiopulmonary bypass time,ventilation time,dosage of positive inotropic drugs,and ICU stay time of group A were shorter compares with group B （P ＜ 0.05）.4 patients in group A （16.00％） suffered from low cardiac output syndrome （LCOS） postoperatively,and 6 in group B（31.58％）.Pulmonary edema occurred in 3 patients,1 in group A（4.00％）,and 2 in group B（10.53％）.Total post-operative mortality was 6.82％ （3/44）.2 cases died of serious LCOS（1 from group A,and the other from group B）,1 cases died of infection and multiple organ dysfunction syndrome（group B）.No significant difference of mortality was observed between two groups.Follow-up data showed some fenestrations can close naturally.Conclusion Keeping atrial septal fenestration can be done as a feasibility tactic in correction of TAPVC with left ventricular hypoplasia.

关 键 词：心脏缺损 先天性 完全性肺静脉异位引流 左心室发育不良 心脏外科手术 

分 类 号：R541.1[医药卫生—心血管疾病]