改良B-T分流术在肺血减少型先天性心脏病中的临床应用  

Modified Blalock-Taussig Shunts for Patients with Congenital Heart Diseases of Diminutive Pulmonary Blood

作　　者：徐朝军[1] 宋岚[2] 尹晓清[1] 王兆礼[1] 杨进[1] 程宇[1] 解鑫隆 张胜康[1] 黄文娟[1] 

机构地区：[1]湖南中医药大学第一附属医院胸心外科,长沙410007 [2]湖南中医药大学生物化学与分子生物学教研室,长沙410208

出　　处：《中国胸心血管外科临床杂志》2015年第5期450-453,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：湖南省自然科学研基金(14JJ7060);湖南省科技计划项目(2013SK3077)~~

摘　　要：目的探讨改良Blalock-Taussig分流术（B-T分流术）在肺血减少型先天性心脏病治疗中的临床应用。方法回顾性分析2007年6月至2013年6月期间湖南中医药大学第一附属医院胸心外科共39例肺血减少型先天性心脏病患者行改良B-T分流术的临床资料,其中男23例、女16例,年龄6个月至16岁（4.64±3.85）岁;体重4.5-43.0（14.81±8.69）kg。结果 39例改良B-T分流术后死亡4例,早期死亡3例（术后30 d内）,早期死亡率7.69%（3/39）。患者术后动脉血氧饱和度与术前差异有统计学意义（64.28%±8.05%vs.81.07%±5.76%（P〈0.01）。随访6个月至6年。28例患者Mc Goon比值（1.11±0.16 vs.1.58±0.22,P〈0.01）和Nakata指数[（113.98±14.84）mm^2/m^2 vs.（160.98±26.65）mm^2/m^2,P〈0.01]均上升,且差异有统计学意义。8例行二期根治手术。结论改良B-T分流术能有效改善患儿缺氧症状,促进肺血管的发育,为二期解剖根治及功能矫治创造条件。Objective To evaluate the surgical outcomes of modified Blalock-Taussig shunts in the patients with congenital heart diseases of diminutive pulmonary blood. Methods We retrospectively analyzed the clinical data of 39 patients with congenital heart diseases of diminutive pulmonary blood,who underwent modified Blalock-Taussig shunts with Gore-Tex vessels in the First Affiliated Hospital, Hunan University of Chinese Medicine between June 2007 and June 2013. There were 23 male and 16 female patients at age of 6 months to 16 years（4.64±3.85） years, body weigh at 4.5-43.0（14.81±8.69） kg. Results There were 4 postoperative deaths. The early mortality was 7.69%（3/39）. The arterial oxygen saturation increased from 64.28%±8.05% to 81.07%±5.76%（P〈0.01）. Ideal pulmonary flow in each patient was obtained. Pulmonary arteries were significantly improved compared with those before operation. Mc Goon ratio（1.11±0.16 versus 1.58±0.22, P〈0.01） and Nakata index（113.98±14.84 mm^2/m^2 versus 160.98±26.65 mm^2/m^2, P〈0.01） increased with a statistical difference. Two-stage radical operations were performed in 8 patients. Conclusions Modified Blalock-Taussig shunt is effective in promoting development of the pulmonary arteries and improving cyanosis significantly. Modified Blalock-Taussig shunt can correct hypoxia to prepare for the radical operation.

关 键 词：改良B-T分流术 先天性心脏病 姑息手术 

分 类 号：R726.5[医药卫生—儿科]