搏动性前向肺血流对复杂紫绀型先天性心脏病双向Glenn术后的影响  

Effects of pulsatile antegrade pulmonary blood flow in patients with complicated cyanotic congenital heart disease after bidirectional Glenn shunting

作　　者：袁源[1] 丁芳宝[1] 鲍春荣[1] 丁士骜 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

出　　处：《中华小儿外科杂志》2015年第8期586-589,共4页Chinese Journal of Pediatric Surgery

基　　金：上海市科委资助项目（项目编号：13XD1403200）

摘　　要：目的回顾性分析保留搏动性前向肺血流对于复杂紫绀型先天性心脏病患儿双．向Glenn术后恢复及肺血管发育的影响。方法收集2009年1月至2013年1月间接受双向Glenn术的171例患儿资料，根据术后是否存在搏动性肺血流分为A组（搏动性血流组，106例）和B组（无搏动血流组，65例），比较两组患儿围手术期临床资料及术后肺动脉发育情况。结果术前两组患儿均存在明显缺氧，两组患儿术前一般情况、Sp02、McGoon比及Nakata指数差异均无统计学意义（P〉0．05）。两组患儿手术时间[A组（126．04±30．78）min，B组（124．57±32．22）min]、用血量[A组（287．25±212．34）ml，B组（262．49±224．32）m13、呼吸机辅助时间[A组（29．67±22．21）h，B组（22．47±18．64）h]、ICU滞留时间[A组（4．26±3．01）d，B组（2．97±1．62）d]、术后住院时间均无统计学意义FA组（10．16±2．48）d，B组（8．54±2．11）d]（P〉0．05），而A组术后引流时间（4．24±2．34）d及引流量（18．42±9．37）ml／kg均高于B组（2．46±1．47）d，（12．50±6．41）ml／kg（P〈0．05）。术后两组患儿缺氧均得到明显改善。术后随访提示术后6个月及1年A组患儿Sp（）2均高于B组，McGoon比及Nakata指数增加大于B组，差异具有统计学意义（P〈0．05）。A组接受二期根治手术时间早于B组，差异具有统计学意义（P〈0．05）。结论保留搏动性前向肺血流可提高Glenn术后患儿血氧含量，有利于肺血管发育及尽早完成二期Fontan手术。但可能增加术后胸腔引流量及延长胸腔引流时间。Objective To explore＇the effects of keeping pulsatile antegrade pulmonary blood flow in pulmonary artery development in patients with complicated cyanotic congenital heart disease after bidirectional Glenn shunting. Methods A total of 171 patients underwent bidirectional Glenn shunt at our department between January 2009 to January 2013. According to the absence or presence of a pulsatile antegrade pulmonary blood flow, they were divided into group A （pulsatile blood flow, n = 106） and group B （non-pulsatile blood flow, n = 65）. Retrospective statistical analyses were conducted for their clinical data and development of pulmonary artery. Results Marked anoxia existed in both groups. No statistically significant inter-group differences existed in general condition, oxygen saturation （SpO2）, McGoon index or Nakata index （P〈0. 05）. No statistically significant inter-group difference existed in operative duration （group A： 126. 04 ± 30. 78 min, group B： 124. 57 ± 32. 22 min）, use of blood （group A： 287. 25 ± 212. 34 ml, group B： 262. 49 ± 224. 32 ml）, ventilation time （group A： 29. 67 ± 22. 21 h, group B： 22. 47 ± 18. 64 h）, intensive care unit （ICLI） stay time （group A： 4. 26 ± 3. 01 days, group B： 2. 97 ± 1.62 days） or postoperative hospitalization length （group A.. 10. 16 ± 2. 48 days, group B： 8. 54 ± 2. 11 days） （P〈0. 05）. However, postoperative drain volume of group A （18. 42 ± 9. 37 ml/kg） was greater than that of group B （12. 50 ± 6. 41 ml/kg） and drainage duration of group A （4. 24 ± 2. 34 days） was longer than that of group B （2. 46 ± 1.47 days） （P〈0. 05）. Anoxia became obviously relieved in both groups after surgery. And SpO2 of group A was higher than that of group B （P〈0. 05）. The increases of McGoon and Nakata indices of group A werefaster than those of group B （P〈0. 05）. Conclusions Preserving a pulsatile antegrade pulmonary blood flow improves the development of pulmonary artery in patie

关 键 词：心脏病 先天性 心脏外科手术 双向格林分流术 

分 类 号：R726.5[医药卫生—儿科]