婴幼儿主动脉弓缩窄手术治疗策略  

Treatment strategy of coarcation of the aorta

作　　者：朱耀斌[1] 张雅娉[2] 李志强[1] 叶赞凯 刘扬[3] 樊星[3] ZHU Yaobin;ZHANG Yaping;LI Zhiqiang;YE Zankai;LIU Yang;FAN Xing(Department of Pediatric Cardiac Surgery,Beijing Children's Hospital Affiliated to Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of Cardiac Surgery,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100037,China;Pediatric Heart Center,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院小儿心脏外科,北京100045 [2]首都医科大学附属北京友谊医院心外科,北京100037 [3]首都医科大学附属北京安贞医院小儿心脏中心,北京100029

出　　处：《中华实用诊断与治疗杂志》2020年第6期565-569,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京市卫生系统高层次卫生技术人才-学科骨干(2015-3-048);北京市卫生系统高层次卫生技术人才-学科骨干(2015-3-051);北京市卫生系统高层次卫生技术人才-学科骨干(2014-3-043);北京市自然科学基金(7184204);北京市自然科学基金(7182042);北京市医管局培育计划(PX2016046);北京市科委首都临床特色应用研究(Z171100001017048)。

摘　　要：目的探讨主动脉弓缩窄(coarcation of the aorta,COA)患者应用不同术式治疗的疗效。方法160例COA婴幼儿,依据病情严重程度分为4组。Ⅰ组39例为单纯COA或COA合并简单心内畸形患儿,切除COA狭窄段行端端吻合术;Ⅱ组64例为合并复杂心内畸形患儿,体外循环下一期矫治弓部病变和心内畸形,并行端端吻合矫治术;Ⅲ组30例为合并主动脉弓发育不良患儿,体外循环下行主动脉弓补片加宽术;Ⅳ组27例为合并主动脉弓发育不良患儿,体外循环下采用扩大端侧吻合术进行主动脉弓重建。记录4组主动脉阻断时间、选择性脑灌注时间、呼吸机辅助时间等;比较术前与术后即刻右侧上下肢脉压差;比较术前跨狭窄段压差、术后3 d跨吻合口压差;记录住院期间生存状况及并发症发生情况;出院后随访观察患儿预后。结果Ⅱ组、Ⅲ组、Ⅳ组主动脉阻断时间、选择性脑灌注时间、入住ICU时间均较Ⅰ组长,且Ⅱ组、Ⅲ组较Ⅳ组长,Ⅱ组较Ⅲ组长(P<0.05);Ⅱ组、Ⅲ组体外循环时间较Ⅳ组长,Ⅱ组较Ⅲ组长(P<0.05);4组呼吸机辅助时间、住院时间比较差异无统计学意义(P>0.05)。Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组术后即刻右侧上下肢脉压差[(2.78±1.24)、(2.84±1.31)、(2.81±1.28)、(3.02±1.34)mm Hg]均低于术前[(39.24±14.25)、(40.21±15.34)、(39.85±15.36)、(40.52±16.37)mm Hg](P<0.05),4组术前、术后即刻右侧上下肢脉压差比较差异无统计学意义(P>0.05)。Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组术后3 d跨吻合口压差[(15.32±5.21)、(15.78±5.47)、(16.02±5.19)、(15.64±5.28)mm Hg]均低于术前跨狭窄段压差[(39.78±19.75)、(40.14±20.02)、(39.92±19.27)、(41.35±21.02)mm Hg](P<0.05),4组术前跨狭窄段压差、术后3 d跨吻合口压差比较差异无统计学意义(P>0.05)。Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组住院期间病死率(2.56%、4.69%、3.33%、3.70%)、并发症发生率(2.56%、7.81%、10.00%、7.41%)比较差异均无统计学意�Objective To explore the effect of different operations on coarcation of the aorta(COA).Methods Totally 160 COA infants was divided into 4 groups according to the severity of disease.Group Ⅰ(n=39)with COA or COA+simple intracardiac anormalies was performed end-to-end anastomosis;group Ⅱ(n=64)with complex cardiac anormalies was performed cardiopulmonary bypass(CPB)to correct aortic arch lesions and intracardiac anormalies,followed by end-to-end anastomosis;group Ⅲ(n=30)with aortic arch dysplasia was performed aortic arch patch widening under CPB;group Ⅳ(n=27)with aortic arch dysplasia was performed aortic arch reconstruction by enlarged end-to-side anastomosis.The time lengths of aortic occlusion,selective cerebral perfusion and ventilator assistance were recorded in 4 groups.The pulse pressure difference between the right upper and lower limbs before and immediately after operation,the pressure difference across the anastomosis,and the pressure difference across the anastomosis on the 3 rd postoperative day were compared.The survival status and complications during hospitalization were recorded.The infants were followed up after discharge.Results The time lengths of aortic occlusion,selective cerebral perfusion and ICU stay were shortened gradually in turn in group Ⅱ,Ⅲ,Ⅳ and Ⅰ(P<0.05).The CPB time was longest in group Ⅱ,followed by group Ⅲ and Ⅳ(P<0.05).There were no significant differences in ventilator assistance time and hospitalization stay among 4 groups(P>0.05).The pulses pressure differences between the upper and lower limbs were lower immediately after operation in groupⅠ,Ⅱ,Ⅲ and Ⅳ((2.78±1.24),(2.84±1.31),(2.81±1.28),(3.02±1.34)mm Hg)than those before operation((39.24±14.25),(40.21±15.34),(39.85±15.36),(40.52±16.37)mm Hg)(P<0.05),and showed no significant differences among 4 groups both before and after operation(P>0.05).The pressure differences across the anastomosis were lower on the 3 rd postoperative day in group Ⅰ,Ⅱ,Ⅲ and Ⅳ((15.32±5.21),(15.78±5.47),(16

关 键 词：主动脉弓缩窄 心脏畸形 主动脉弓发育不良 心脏手术 

分 类 号：R726.5[医药卫生—儿科]