新法矫治主动脉缩窄  

New method for correction of coarctation of the aorta

作　　者：杨学勇[1] 景小勇[1] 陈哲[1] 李论[1] 范详明 苏俊武[1] 刘迎龙[1] YANG Xueyong;JING Xiaoyong;CHEN Zhe;LILun;FAN Xiangming;SU Junwu;LIU Yinglong(Pediatric Cardiovascular Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏中心

出　　处：《心肺血管病杂志》2019年第11期1150-1153,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨不同方法治疗主动脉弓缩窄的疗效。方法:从2017年1月到2018年6月我们尝试一种新的方法矫治主动脉缩窄15例。在非体外循环下阻断主动脉进行矫治手术期间,将监测上、下肢动脉血压的通路通过侧支管路连通,使缩窄段近端高压的血流可以通过侧支管路分流到低压的缩窄段远端,增加主动脉阻断期间缩窄段远端的血供,使手术安全时限延长。关闭侧支通路时可以检验缩窄矫形效果。取同期未采用此方法,但诊断、年龄和缩窄程度等特征匹配的18例患儿做对比。结果:分别采用新旧两种方法的两组患儿术后均没有残余压差,主动脉阻断时间和术后上下肢压差差异无统计学意义(P≥0.05)。但吻合期间缩窄远端的血压差异有统计学意义(P≤0.01)。结论:新法使手术操作更加从容,虽然与前期方法相比,矫治效果无显著的差异,这可能是病例数较少的缘故。但此法优势明显,值得推广。Objective:To investigate the effect of different method for correction of coarctation of the aorta.Methods:From January 2017 to June 2018,we used a new method to correct 15 cases of coarctation of the aorta without cardiopulmonary bypass.During operations,we kept continuous invasive arterial pressure monitoring by puncture needles and extension tubes on upper and lower limbs.The two respective extension tubes on the upper and lower limb of a patient are connected by an extension tube with a switch.During the aorta was blocked,the switch remains open and the patient’s blood is diverted from the high-pressure upper limb to the low-pressure lower limb by the extension tube.This increased the blood supply to the distal end of the patient during aortic occlusion and prolonged the safe time limit for surgery.When the collateral pathway is closed,the effect of the operation can be tested.This method was not used on 18 children with matched characteristics such as diagnosis,age and extent of coarctation,and so on in the same period.Results:There were no residual deformities after operation with the new and old method.There was no significant difference in aortic occlusion time and surgical effect between the two groups(P≥0.05).During arterial anastomosis,there was a significant difference in blood pressure of distal limbs between the two groups(P≤0.01).Conclusions:The new method makes the operation more easy.Although there is no significant difference in the effect of correction compared with the previous method,this may be due to the fewer cases.But this method has obvious advantages and is worth popularizing.

关 键 词：先天性心脏病 主动脉缩窄 外科手术 

分 类 号：R54[医药卫生—心血管疾病]