ALCAPA术后心功能的支持及临床转归  

Cardiac function support after ALCAPA operation and its early outcome

作　　者：李志浩[1] 蔡及明[1] 徐卓明[1] 张海波[1] 郑景浩[1] Li Zhihao;Cai Jiming;Xu Zhuoming;Zhang Haibo;Zheng Jinghao(Department of Cardiothoracic Surgery,Shanghai Children Medical Center,Shanghai 200127,China)

机构地区：[1]上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2020年第3期162-167,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结左冠状动脉起源于肺动脉(ALCAPA)术后心功能的支持方法及变化特点,分析术后早期死亡的危险因素和临床转归。方法回顾性分析2005年1月至2017年12月上海儿童医学中心收治的108例ALCAPA患儿的临床资料,按照手术时年龄分为<1岁组(65例)和>1岁组(43例)。采用左心室射血分数(LVEF)、左心室舒张期末期直径(LVEDD)Z值描述术后心功能变化情况;总结术后血管活性药物的选择和使用要点,采用血管药物评分(VIS)反映术后心功能对血管活性药物的依赖程度,间接反映心功能状况;总结术后启用和终止机械辅助以及停止机械通气的指征。结果ALCAPA术后早期心功能虽较术前有所改善,但仍未能恢复至正常范围。术后第5天两组LVEF分别为0.42、0.45,LVEDD的Z值分别为3.47、2.74。术后血管活性药物的选择以同时兴奋α、β受体的肾上腺素和去甲肾上腺素为主。VIS评分较高。机械循环辅助18例。全组死亡12例(11%)。多因素logistic回归分析显示手术时低年龄和低LVEF水平是术后早期死亡的危险因素。结论ALCAPA术后早期心功能仍处于较低水平,依赖大剂量的血管活性药物和必要的机械辅助。我们推荐撤离呼吸机和机械辅助的指征分别为LVEF>0.40和LVEF>0.35,并结合其他临床指标。术前低年龄和低LVEF水平是影响术后死亡的危险因素。Objective To summarize cardiac function feature and its support method after ALCAPA(anomalous origin of left coronary arteries from pulmonary artery)operation.Analysis its early outcome and risk factors of its mortality.Methods Review the clinical data of 108 ALCAPA cases treated in Shanghai Children Center between January 2005 and December 2017.All the cases were divided into two groups according to their ages when they received the surgery:group 1<1 yr;group 2>1yr.Adopted LVEF(left ventricle ejection fraction)and LVEDD(left ventricle end-diastolic diameter)Z-score as a parameter to describe the cardiac function change after operation.Summarize the selection and application of vasoactive agents and its score(VIS)after operation,indirectly reflect the post-operative cardiac function.Analysis the opportunityofinitiation and termination of mechanical circulation support and the timefor mechanical ventilationevacuation.Adopt the logistic analysis to find the risk factors of early death risk factors after ALCAPA operation.Results Cardiac function had little improve in early period after ALCAPAoperation,did not attained normal range in fifth day post-operative,LVEF was 0.42 in group 1 and 0.45 in group 2,respectively.The application of vasoactive agents tended to chooseα,βreceptor-agonist,which epinephrine and norepinephrine is the preferred and VIS score was high in early period.Mechanical circulation support was used in 18 cases.12 cases died in our group,mortality was 11%.Logistic regression analysis implied that low age and low level of LVEF before operation is the risk factor for mortality.Conclusion Cardiac function was still in low level in early period after ALCAPA operation,depended on higher dosage of vasoactive agents and mechanical circulation support if necessary.We recommend the LVEF index for evacuated from mechanical circulation support and mechanical ventilation is over 0.40 and 0.35 respectively,and other clinical sign should be considered simultaneously.Low age and low LVEF level before operation

关 键 词：先天性心脏病 左冠状动脉起源于肺动脉 血管活性药物 机械循环辅助 

分 类 号：R726[医药卫生—儿科]