完全性大动脉转位新生儿大动脉调转术后延迟关胸的病例对照研究  

Application of delayed sternal closure following arterial switch operation for neonates with transposition of great arteries(D-TGA): A case control study

作　　者：李晓峰 庄建[1] 陈寄梅[1] 罗丹东[1] 朱卫中[1] LI Xiaofeng;ZHUANG Jian;CHEN Jimei;LUO Dandong;ZHU Weizhong(Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Department of Cardiovascular Surgery,Guangdong Provincial Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510100,P.R.China)

机构地区：[1]广东省医学科学院广东省人民医院广东省心血管病研究所心外科广东省华南结构性心脏病重点实验室,广州510100

出　　处：《中国胸心血管外科临床杂志》2018年第10期834-838,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划课题(2011BAI11B22);国家自然科学基金资助项目(U1401255);广东省医学科学技术研究基金(A2017522)

摘　　要：目的研究完全性大动脉转位新生儿大动脉调转术后延迟关胸的应用情况。方法回顾性分析2009年6月1日至2015年12月31日我院心外小儿科收治的完全性大动脉转位新生儿172例的临床资料。根据术后是否延迟关胸将其分为两组:延迟关胸组118例,其中男99例、女19例;非延迟关胸组54例,其中男47例、女7例。比较两组患儿的临床结效果。结果术前机械通气(P<0.001)、急诊手术(P=0.023)、体外循环时间(P<0.001)是延迟关胸的危险因素;延迟关胸组胸骨正中切口并发症的发生率较非延迟关胸组无明显增高(P=0.986);延迟关胸新生儿的死亡率显著高于非延迟关胸组(P=0.006),但是延迟关胸不是患儿死亡的危险因素。结论延迟关胸不增加胸骨正中切口并发症的发生率,也不是导致患儿死亡的危险因素,合理应用延迟关胸有助于患儿术后的早期恢复。Objective To investigate the application of delayed sternal closure （DSC） following arterial switch operation for neonates with transposition of great arteries （D-TGA）. Methods We retrospectively analyzed clinical data of 172 neonates underwent arterial switch operation with transposition of great arteries （D-TGA） between June 1st 2009 and December 31st 2015. These neonates were divided into 2 groups including a DSC group （118 patients with 99 males and 19 females） and a non-DSC group （54 patients with 47 males and 7 females）. The outcome of the two groups were compared. Results Preoperative mechanical ventilation（P〈0.001）, emergency surgery （P=0.023） and extracorporeal circulation time （P〈0.001） were the risk factors for delayed sternal closure. The incidence of complications of median sternotomy incision in the DSC group was not higher than that in the non-DSC group. The mortality rate in the DSC group was markedly higher than that in the non-DSC group （P〈0.001）. However, DSC was not a risk factor for the death of the neonates. Conclusion Delayed sternal closure does not increase the incidence of complications of the median sternotomy incision, nor is it a risk factor for the death of the neonates. Reasonable application of delayed sternal closure is helpful for early postoperative recovery of the neonates.

关 键 词：延迟关胸 婴儿 新生儿 大动脉调转术 正中胸骨切口 死亡率 

分 类 号：R726.5[医药卫生—儿科]