大动脉调转术治疗婴儿大动脉转位近期疗效观察  

Short-term effect of arterial switch operation in the treatment of transposition of great arteries in infants

作　　者：王鹏高 崔亚洲 陈忠建 于文波[1] 翟波 WANG Penggao;CUI Yazhou;CHEN Zhongjian;YU Wenbo;ZHAI Bo(Department of Thoracic and Cardiovascular Surgery,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450018,Henan Province,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院胸心外科,河南郑州450018

出　　处：《新乡医学院学报》2020年第8期729-733,共5页Journal of Xinxiang Medical University

基　　金：河南省科技攻关项目(编号:162102310224)。

摘　　要：目的探讨大动脉调转术治疗婴儿大动脉转位的近期临床效果。方法选择2014年6月至2019年7月郑州大学附属儿童医院收治的38例大动脉转位婴儿为研究对象,所有患儿施行大动脉调转术治疗。记录患儿手术时间、主动脉阻断时间、住院时间、术中出血量及监护室入住时间,观察并发症发生情况,并统计患儿术后3个月病死率;分别于术前及术后1、3、5 d采用酶联免疫吸附法检测血清β-内啡肽(β-EP)、高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、醛固酮(ALD)水平;术前及术后3个月,应用彩色多普勒超声诊断系统检测术后主动脉瓣环内径、主动脉根部内径、肺动脉内径、肺动脉瓣环内径,观察主、肺动脉发育情况;应用超声心动图仪检测患儿左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、心脏指数(CI)。结果38例大动脉转位患儿的手术时间、主动脉阻断时间、住院时间、术中出血量、监护室入住时间分别为(256.31±20.33)min、(149.62±16.69)min、(15.71±3.74)d、(188.65±51.35)mL、(6.04±1.42)d。38例大动脉转位患儿发生低心排血量综合征2例,创口愈合不良2例,肺动脉狭窄1例,心律失常1例,痰培养细菌阳性3例,并发症发生率为23.68%(9/38)。术后1、3 d患儿血清β-EP、hs-CRP、IL-6、ALD水平均显著高于术前(P<0.05);术后5 d患儿血清β-EP、hs-CRP、IL-6、ALD水平与术前比较差异均无统计学意义(P>0.05)。术后3个月,38例患儿失访3例,死亡4例。获得随访的31例患儿术后3个月主动脉根部内径、肺动脉内径均小于术前(P<0.05);但术后3个月患儿主动脉瓣环内径、肺动脉瓣环内径与术前比较差异均无统计学意义(P>0.05)。获得随访的31例患儿术后3个月时LVEF、CI显著大于术前,LVEDD、LVESD显著小于术前(P<0.05)。结论大动脉调转术治疗婴儿期大动脉转位近期疗效良好,能有效纠正患儿大动脉畸形,�Objective To investigate the short-term effect of arterial switch operation in the treatment of transposition of great arteries in infants.Methods Thirty-eight infants with transposition of great arteries admitted to the Children′s Hospital Affiliated to Zhengzhou University from June 2014 to July 2019 were selected as the subjects.All infants were treated with arterial switch operation.The operation time,aortic occlusion time,hospitalization time,intraoperative bleeding and the occupancy time in the intensive care unit were recorded.The complications were observed and the fatality rate of the children within 3 months after operation was counted.The levels of serumβ-endorphin(β-EP),high-sensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and aldosterone(ALD)were detected by enzyme-linked immunosorbent assay before and 1,3,5 days after operation.The internal diameters of aortic annulus,aortic root,pulmonary artery and pulmonary valve annulus were detected by color Doppler ultrasound before and 3 months after operation,so as to observe the development of the aorta and pulmonary arteries.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and cardiac index(CI)were measured by echocardiography.Results The operation time,aortic occlusion time,hospitalization time,intraoperative bleeding and the occupancy time in the intensive care unit of the 38 patients with transposition of great arteries were(256.31±20.33)min,(149.62±16.69)min,(15.71±3.74)d,(188.65±51.35)mL and(6.04±1.42)d,respectively.There were two cases of low cardiac output syndrome,two cases of poor wound healing,one case of pulmonary artery stenosis,one case of arrhythmia and 3 cases of positive sputum culture,the incidence of complications was 23.68%(9/38).The serum levels ofβ-EP,hs-CRP,IL-6 and ALD at 1 and 3 days after operation were significantly higher than those before operation(P<0.05).There was no significant difference in serum levels ofβ-EP,hs-CRP,IL-

关 键 词：大动脉转位 大动脉调转术 先天性心脏病 

分 类 号：R726.5[医药卫生—儿科]