成人重度肺动脉瓣狭窄外科治疗临床观察  

Effects of surgical treatment for severe pulmonary stenosis in adults

作　　者：张春振[1] 方敏华[1] 王镇龙[1] 张永[1] 吴洪江[1] ZHANG Chun-zhen;FANG Min-hua;WANG Zhen-long;ZHANG Yong;WU Hong-jian(Department of Cardiovascular Surgery,The General Hospital of Shenyang Military Command,Shenyang 110016,China)

机构地区：[1]沈阳军区总医院心血管外科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2018年第2期90-92,共3页Trauma and Critical Care Medicine

基　　金：辽宁省科学技术计划项目(2014225015)

摘　　要：目的观察成人重度肺动脉瓣狭窄(PS)外科手术治疗的方法与疗效。方法选取自2010年1月至2015年6月经外科手术治疗的28例成人重度PS患者为研究对象,肺动脉瓣交接切开+右室流出道疏通9例(三尖瓣口疏通右室流出道4例,右室流出道切口疏通右室流出道5例);跨瓣环右室流出道带瓣补片加宽术19例,其中,1例行11/2心室修复(跨瓣环右室流出道带瓣补片加宽+上腔静脉与右肺动脉的腔肺血管吻合)。同时,于术中矫治其他合并心内畸形。观察患者术后疗效及不良反应发生情况。结果全组呼吸机使用时间8~96 h,平均(14.0±6.1)h;心肺转流时间45~135 min,主动脉阻断时间30~65 min,二次转流2例。术后呼吸机辅助时间4~450 h,ICU滞留时间2~20 d。病死1例,病死率3.6%(1/28);早期并发症开胸止血1例,低心排8例,胸腔积液6例,肺不张2例,急性肾衰竭1例,低氧血症5例。出院前心脏超声提示,27例患者均右室流出道通畅,心脏功能良好,右心室至肺动脉血流速1.5~3.5 m/s。其中,合并肺动脉瓣轻度返流6例,中度2例;合并三尖瓣中度返流1例,其余均关闭良好。门诊随访22例,随访率81.5%(22/27),随访1个月至5年。随访均行心脏超声、心电图、X线影像检查,患者术后心功能良好,右室至肺动脉未见明显压力阶差。结论外科手术是治疗成人重度PS患者的有效方法,正确术式选择、合理术后处理是治疗的关键。Objective To investigate the effect of surgical treatment for severe pulmonary stenosis(PS)in adults.Methods A retrospective study was performed on 28 cases of adult patients with severe pulmonary stenosis who underwent surgical treatment from January 2010 to June 2015.Among the 28 cases,9 cases were performed pulmonary valve transfer incision+right ventricular outflow tract(RVOT)(three tricuspid mouth dredge to clear RVOT in 4 cases,RVOT incision to clear the RVOT in 5 cases);19 cases of routine transannular RVOT monocusp widening surgery,including 1 cases of 11/2 ventricular repair(pulmonary vascular cavity transannular RVOT monocusp widened+the superior vena cava and right pulmonary artery anastomosis,BDG).Meanwhile,intraoperative correction of other intracardiac deformity.The postoperative curative effect and adverse reactions were observed.Results The using time of ventilator in the whole group was 8-96 hours,mean time(14.0±6.1)hours;cardiopulmonary bypass time was 45-135 minutes,aortic block time was 30-65 minutes,second turn flow in 2 cases.Postoperative ventilator assisted time was 4-450 hours,and the retention time of ICU was 2-20 days.One patient died of surgery,and the mortality rate was 3.6%(1/28).There were 1 case of chest hemostasis in early postoperative complications,8 cases of low cardiac discharge,6 cases of pleural effusion,2 cases of atelectasis,1 case of acute renal failure,and 5 cases of hypoxemia.Before discharge,echocardiography indicated that the RVOT was unobstructed,the cardiac function was good,and the flow velocity of the right ventricle to the pulmonary artery was 1.5-3.5 m/s.The pulmonary valve regurgitation was mild in 6 cases,moderate in 2 cases,and 1 case of tricuspid valve moderate regurgitation,and the rest valves were closed well.Follow-up was performed in 22 cases of outpatients,the follow-up rate was 81.5%(22/27),duration of follow-up was 1 months to 5 years.All followed up patients were performed echocardiography,electrocardiogram and chest X-ray examination.The postoperat

关 键 词：肺动脉瓣狭窄 心功能不全 右室流出道 血管吻合 

分 类 号：R654.2[医药卫生—外科学]