左冠状动脉起源于肺动脉合并重度左心功能不全的外科治疗  

Surgical Treatment in Patients With Anomalous Left Coronary Artery From Pulmonary Artery Combining Severe Left Ventricular Dysfunction

作　　者：张昌伟[1] 李守军[1] 张浩[1] 高华炜[1] 晏馥霞[1] 刘晋萍[1] 王旭[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿外科中心,北京市100037

出　　处：《中国循环杂志》2017年第9期917-920,共4页Chinese Circulation Journal

摘　　要：目的:总结左冠状动脉起源于肺动脉(ALCAPA)合并重度左心功能不全患者的外科治疗结果。方法:回顾性分析2009-02至2016-04,我院小儿外科中心采用冠状动脉再植治疗ALCAPA合并重度左心功能不全患者[左心室射血分数(LVEF)<30%]24例,男性13例,中位年龄7.0(5.0,17.8)个月,术前中位LVEF值为21.0%(17.3%,26.5%)。结果:24例患者院内死亡2例(8.3%),体外循环中位时间109(95,128)min,主动脉阻断中位时间65(48,87)min,呼吸机辅助中位时间94.5(48.3,165.5)h,住重症监护病房中位时间176.5(101.0,305.3)h,2例患者行体外膜肺氧合(ECMO)辅助并成功脱机,二次气管插管2例。22例患者出院时LVEF为26.0%(20%,35%)与术前比较差异无统计学意义(P>0.05)。22例患者平均随访时间(15.3±14.9)个月,最长随访63个月,随访期间无再次入院、再次手术和死亡,心功能分级均为纽约心脏协会(NYHA)心功能分级Ⅰ级,最后一次随访LVEF 60%(50%,69%)较出院时显著提高(P<0.05),4例患者LVEF<50%。结论:对于ALCAPA合并重度左心功能不全的患者,外科治疗仍具有满意的近中期效果,其围术期处理强调外科、麻醉、体外循环以及术后监护室的综合努力。Objective： To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery （ALCAPA） combining severe left ventricular dysfunction. Methods： A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied. The patients＇ mean age was 7.0 （5.0, 17.8） months including 13 male; mean left ventricular ejection fraction （LVEF）〈30% and the median pre-operative LVEF was 21.0% （17.3%, 26.5%）. Results： There were 2/24 （8.3%） in-hospital death, The median cardiopulmonary bypass time was 109 （95, 128） min, aorta cross-clamp time 65 （48, 87） min, mechanical ventilation time 94.5 （48.3, 165.5） h and ICU stay time 176.5 （101.0, 305.3） h; 2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation. In 22 survival patients, the median discharge LVEF was 26.0% （20%, 35%） which was similar to pre-operative condition, P〉0.05. The mean follow-up time was （15.3±14.9） months at the longest of 63 months, no re-admission, re- operation and death occurred. The patients had NYHA I and the last follow-up LVEF was 60% （50%, 69%） which was increased than discharge level, P〈0.05, 4 patients had LVEF〈50%. Conclusion： Surgical treatment had satisfactory short- and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction; comprehensive effort should be emphasized in surgery, anesthesia, cardiopulmonary bypass and ICU management at peri-operative period.

关 键 词：心血管畸形 血管移植 心室功能障碍 左 

分 类 号：R541[医药卫生—心血管疾病]