完全性肺静脉异位连接矫治术135例临床预后分析  

Clinical prognostic analysis of 135 patients after surgical correction of total anomalous pulmonary venous connection

作　　者：余鹏飞[1] 朱海龙[1] 金振晓[1] 段维勋[1] 梁洪亮[1] 杨秀玲[1] 俞世强[1] 

机构地区：[1]第四军医大学西京医院心血管外科,西安710032

出　　处：《中国体外循环杂志》2016年第2期95-99,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(81570231;81570230;81570232);陕西省国际科技合作与交流计划项目(2015KW-047)

摘　　要：目的通过分析本中心完全性肺静脉异位连接（TAPVC）手术病例的预后,寻找影响手术早期及晚期预后的相关因素。方法收集本中心在2003年至2014年手术治疗的135例TAPVC患者,男/女：76/59;年龄中位数为7个月,四分位数范围1天-42个月,体重中位数为6.2 kg,四分位数范围为4.95-10.5 kg。按TAPVC亚型分类：心上型48.9%,心内型44.4%,心下型1.4%,混合型5.1%。单纯合并房间隔缺损的TAPVC占77.8%,合并其他先天性心脏病的TAPVC占22.2%,包括室间隔缺损、动脉导管未闭、二尖瓣脱垂、三尖瓣关闭不全、肺动脉瓣狭窄、主动脉弓缩窄、单心房和单心室等。结果手术总死亡率9.9%（13/135）,单纯合并房间隔缺损患者死亡率6.7%,合并其他先天性心脏病患者死亡率20%。与死亡相关的因素包括：低体重（〈6 kg,P〈0.001）,体外循环时间〉150 min（P=0.001）,单心室（P=0.005）,主动脉阻闭时间〉60 min（P=0.043）。结论 TAPVC患儿合并畸形的复杂程度,低体重,较长的体外循环时间和主动脉阻闭时间是影响手术预后的危险因素。Objective In order to explore the related factors that influence the early and late prognosis after the operation,clinical data of 135 children underwent TAPVC repair in our center were analyzed.Methods One hundred and thirty five consecutive-cases of children who underwent TAPVC surgical repair in 2003- 2014 were included in this study： M/ F, 76/ 59; median age 7months; median weight 6.2 kg. Anatomic types of TAPVC were： supracardiac type 48.9%, intracardiac type 44.4%, infracardiac type1.4%, and mixed type 5.1%. Patients with no heart defects other than an atrial septal defect（ASD） made up 77.8% of the series, and22.2% of the patients with heart defects other than ASD including ventricular septal defect, patent ductus arteriosus, mitral valve pro-lapsed, pulmonary stenosis, coarctation of aorta, single ventricle and single atrium.Results The overall operative mortality was 9.9%（13/ 135）. Children with isolated ASD had a lower mortality than those with other heart defects（6.7% vs 20%,P = 0.04）. Factors as-sociated with perioperative mortality included low body weight（〈6 kg,P〈0.001）,single ventricle physiological status（P = 0.005）,long cardiopulmonary bypass time（〉150 minutes,P = 0.001） and long aortic cross-clamp time（〉60 min,P = 0.043）.Conclusion The anatomic complexity of the defect, low body weight, long extracorporeal circulation time and long aortic crossclamp time are signifi-cant factors associated with post-operative mortality in children undergoing TAPVC correction.

关 键 词：先天性心脏病 完全性肺静脉异位连接 心脏外科手术 预后 

分 类 号：R726.5[医药卫生—儿科]