新生儿室间隔完整型大动脉转位的外科治疗时机及预后  

Surgical timing and outcome of arterial switch operation for neonates with transposition of the great arteries with intact ventricular septum

作　　者：王辉 洪小杨 刘宇航 王刚 陈曦 辛成雷 周更须 WANG Hui HONG Xiao-yang LIU Yu-hang WANG Gang CHEN Xi XIN Cheng-lei ZHOU Geng-xu(Department of Cardiac Surgery,, Bayi Children ＂s Hospital Affiliated to Chinese People＇s Liberation Army General Hospital Beijing 100700, China)

机构地区：[1]陆军总医院附属八一儿童医院心脏外科,北京100700

出　　处：《发育医学电子杂志》2016年第3期148-151,共4页Journal of Developmental Medicine (Electronic Version)

摘　　要：目的分析大动脉调转术（artery switch operation，ASO）治疗新生儿室间隔完整型大动脉转位（transposition of the great arteries with intact ventricular septum，TGA／IVS）的手术时机和预后。方法回顾性分析2012年2月至2015年2月，在陆军总医院附属八一儿童医院接受ASO治疗的25例新生儿病历资料，急诊手术组13例，限期手术组12例，比较2组儿的手术预后。结果25例患儿中，男19例，女6例。急诊手术组与限期手术组的性别比例、早产儿比例、出生体重、入院时日龄、手术时体重、手术时日龄、大动脉位置关系等指标比较，差异均无统计学意义（P值均〉0．05）。急诊手术组入院至手术时间短于限期手术组[1．0（1．0-1．5）与9．5（8．3～14．8）天，T=91．000，P〈0．05].急诊手术组患儿术前机械通气的比例高于限期手术组（13／13与3／12，Z2=15．234，P〈0．05），术前氧分压低于限期手术组[23（17～27）与30（23-45）mmHg，T=127．000，P〈0．05].2组术中体外循环时间、主动脉阻断时间、延迟关胸比例比较，差异均无统计学意义（P值均〉0．05）。急诊手术组与限期手术组术后早期出现低心排综合征的比例（2／13与1／12，X^2=0．294）、术后早期死亡的比例（1／13与1／12，X^2=O．003）、以及总住院时间[26．0（18．5～27．5）与33．5（21.5-40．8）天，T=150．500]比较，差异均无统计学意义（P值均〉0．05）。结论急诊ASO手术治疗新生儿TGA／IVS，采用合理的围术期处理，可取得较好的近、远期效果。Objective To analyze the surgical timing and outcome of artery switch operation （ASO） for neonates with transposition of the great arteries with intact ventricular septum （TGA/IVS）. Methods 25 patients underwent ASO from February 2012 to February 2015 were analyzed retrospectively. There were 13 cases in group of emergency operation （group A）, and 12 cases in group of selective operation （group B）. The surgical outcomes of two groups were compared. Results There were 19 male cases and 6 female cases among the 25 patients. The indexes of sex ratio, proportion of premature infants, birth weight, age at hospitalization, weight at operation, age at operation and artery location of the two groups were no statistically different （P〉0.05）. The duration of admission to operation of group A was shorter than that of group B [ 1.0 （1.0-1.5） vs 1.0 （8.3-14.8） d, T=91.000, P〈0.05）] . The ratio of pre-operation mechanical ventilation of group A was higher （13/13 vs 3/12, X^2=15.234, P 〈 0.05）, while pre-operative oxygen partial pressure was lower than that of group B [ 23 （17-27） vs 30 （23-45） mmHg, T=127.000, P〈0.05） ] . Therewere no statistically difference （P〉0.05） in extracorporeal circulation time, aorta blocking time and the ratio of delayed sternal closure. Meanwhile, the proportion of early low cardiac output syndrome （2/13 vs 1/12, X^2=0.294）, the proportion of early post-operative death （1/13 vs 1/12, X^22 = 0.003）, and the duration of hospital stay 1 26.0 （18.5-27.5） vs 18.5 （21.5-40.8） d, T=150.500 1 of the two groups were no statistically different （P〉0.05）. Conclusion Reasonable perioperative management in neonates with TGA/IVS can obtain better short-and long-term efficacy.

关 键 词：新生儿 室间隔完整型大动脉转位 外科手术治疗 

分 类 号：R722.1[医药卫生—儿科]