发绀型先天性心脏病多次体肺分流术的体会  

Experience of operation for children with cyanotic congenital heart disease who undergo systemic-pulmonary shunts repeatedly

作　　者：杨学勇[1] 景小勇[1] 陈哲[1] 李论[1] 范祥明[1] 苏俊武[1] YANG Xueyong;JING Xiaoyong;CHEN Zhe;LI Lun;FAN Xiangming;SU Junwu(Department of Pediatric Cardiovascular Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vesess 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,100029

出　　处：《心肺血管病杂志》2020年第5期514-517,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:发绀型先天性心脏病施行两次或者多次体肺分流术的病例不断增多,而相关报道比较少,本文总结了我院这方面的手术经验。方法:对我院在2010年10月至2019年3月期间,施行两次及两次以上体肺分流术的先天性心脏病患儿65例进行手术方法、肺血管发育状况等方面进行分析。结果:术后早期,患儿发绀均改善,血氧饱和度显著增加。住院期间死亡1例(1.5%),为术后房室瓣反流加重、低心排出量综合征、肝衰竭所致。术后早期并发症18例(27.7%)。存活患儿每3~6个月来我院随访,随访期间McGoon指数显著升高,部分患儿得到根治。结论:发绀型先天性心脏病患儿行再次行体肺分流术时操作困难,风险大。但如果方法得当,则总体风险可控,可促进肺血管发育、改善发绀、增加根治手术的机会。Objective:Children with cyanotic congenital heart disease may undergo systemic-pulmonary shunts twice or more.The number of such cases is increasing,but the relevant reports are relatively few.This paper summarizes the experience of this kind of surgery in our hospital.Methods:From October 2010 to March 2019,65 children with congenital heart disease underwent two systemic-pulmonary shunts twice or more.We analyzed the method of operation and the development of pulmonary vessels,etc.Results:Early after operation,cyanosis was ameliorated and oxygen saturation increased significantly.One case(1.5%)died during hospitalization due to worsening atrioventricular regurgitation,low cardiac output syndrome and liver failure.Early complications occurred in 18 cases(27.7%).Surviving children were followed up every 3 to 6 months in our hospital.During the follow-up period,McGoon index increased significantly,and some children were cured.Conclusions:It is difficult and risky for children with cyanotic congenital heart disease to undergo operation of systemic pulmonary shunt twice or more.However,if appropriate,the overall risk can be controlled,which can promote pulmonary vascular development,improve cyanosis and increase the chance of radical surgery.

关 键 词：先天性心脏病 发绀 再次手术 

分 类 号：R54[医药卫生—心血管疾病]