婴幼儿复杂先天性心脏病双向Glenn术治疗效果观察  

Effect of Bidirectional Glenn Operation on Infants and Young Children with Complex Congenital Heart Disease

作　　者：邓明彬 朱宏斌 付勇 方易冰 DENG Mingbin;ZHU Hongbin;FU Yong;FANG Yibing(Department of Cardiothoracic Surgery,the Affiliated Hospital of Southwest University of Medical Sciences,Luzhou 646000,China;Department of Cardiothoracic Surgery,Shanghai Children′s Medical Center,Shanghai 200127,China)

机构地区：[1]西南医科大学附属医院心胸外科,四川泸州646000 [2]上海儿童医学中心心胸外科,上海200127

出　　处：《医学综述》2018年第14期2881-2885,共5页Medical Recapitulate

摘　　要：目的探讨双向Glenn术治疗婴幼儿复杂先天性心脏病(先心病)的临床效果。方法选择2012年1月至2016年3月在西南医科大学附属医院行双向Glenn术治疗的复杂性先心病婴幼儿84例,其中在非体外循环下行双向Glenn术的52例为非体外循环组,在体外循环下行双向Glenn术的32例为体外循环组;非体外循环组根据术中是否建立临时旁路分为右心旁路组(31例)和非右心旁路组(21例)。比较非体外循环组与体外循环组、右心旁路组与非右心旁路组手术病死率、症状体征改善情况、心功能分级情况,平均肺动脉压、呼吸机使用时间、脉搏血氧饱和度、血红蛋白水平情况以及并发症发生情况。结果所有患儿术后症状体征均明显改善,吻合口血流通畅,无患儿死亡。术后心功能分级非体外循环组优于体外循环组(P<0.05),但右心旁路组与非右心旁路组比较差异无统计学意义(P>0.05)。非体外循环组术后肺动脉压和血红蛋白水平低于体外循环组[(14.6±2.1)mmHg(1 mmHg=0.133 kPa)比(18.4±3.2)mmHg,(143.8±11.4)g/L比(153.5±20.6)g/L,P<0.05],脉搏血氧饱和度高于体外循环组[(89.4±3.8)%比(79.3±6.0)%,P<0.01]、辅助通气时间和住院时间短于体外循环组[(10.3±1.3)h比(18.7±3.5)h,(8.8±4.3)d比(13.5±6.3)d,P<0.01];右心旁路组术后辅助通气时间短于非右心旁路组[(7.6±1.1)h比(13.5±2.2)h,P<0.05]。非体外循环组并发症发生率低于体外循环组[9.62%(5/52)比28.13%(9/32),P<0.05];右心旁路组低于非右心旁路组[3.2%(1/31)比19.0%(4/21),P<0.05]。结论非体外循环下双向Glenn术治疗婴幼儿复杂性先心病能取得满意的效果,术中应尽可能建立右心旁路。Objective To explore the effect of bidirectional Glenn operation on infants and young children with complex congenital heart disease. Methods From Jan. 2012 to Mar. 2016,a total of 84 infants and young children with complex congenital heart disease received bidirectional Glenn operation in the Affiliated Hospital of Southwest University of Medical Sciences were included：52 patients given bidirectional Glenn operation with non-extracorporeal circulation as a non-extracorporeal circulation group,and 32 patients given the operation under the extracorporeal circulation as an extracorporeal circulation group.According to intraoperative temporary bypass,the non-extracorporeal circulation group was divided into a right heart bypass group（31 cases） and a non-right heart bypass group（21 cases）.The right heart bypass group and non-right heart bypass group on mortality,symptoms and signs,grade of cardiac function,mean pulmonary artery pressure,breathing machine time,pulse oxygen saturation,hemoglobin level and complications of the non-extracorporeal circulation group and extracorporeal circulation group were compared. Results The postoperative symptoms and signs improved significantly,anastomotic blood flowing,no deaths.The cardiac function of the non-extracorporeal circulation group was better than that of the extracorporeal circulation group （ P 〈0.05）,but there was no statistical significance between the right heart bypass group and the non-right heart bypass group（ P 〉0.05）.The postoperative pulmonary artery pressure and hemoglobin level of the non-extracorporeal circulation group were lower than those of the extracorporeal circulation group [（14.6± 2.1） mmHg vs （18.4±3.2） mmHg,（143.8±11.4） g/L vs （153.5±20.6） g/L, P 〈0.05],oxygen saturation was higher than that of the extracorporeal circulation group[（89.4±3.8）% vs （79.3±6.0）%, P 〈0.01],assisted ventilation time and hospitalization time were less than those of the extracorporeal circulation group[（10.3±1.3�

关 键 词：先天性心脏病 双向GLENN术 非体外循环 右心旁路 

分 类 号：R654.2[医药卫生—外科学] R255.4[医药卫生—临床医学]