根治性大动脉调转术后应用大剂量血管活性药物的有效性及安全性  

Efficacy and safety of high-dose vasoactive drugs after radical arterial switch operation

作　　者：车强 张卫达 蔡志祥 张本 董柱 王显悦 张加俊 俞世强 CHE Qiang;ZHANG Weida;CAI Zhixiang;ZHANG Ben;DONG Zhu;WANG Xianyue;ZHANG Jiajun;YU Shiqiang(Xi'an Daxing Hospital,Xi'an 710016;General Hospital of Southern Theatre Command of the Chinese People's Liberation Army,Guangzhou 510010;the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433;the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]西安大兴医院,陕西西安710016 [2]中国人民解放军南部战区总医院,广东广州510010 [3]海军军医大学第一附属医院,上海200433 [4]空军军医大学第一附属医院,陕西西安710032

出　　处：《临床医学研究与实践》2020年第30期12-14,共3页Clinical Research and Practice

基　　金：国家重点研发计划项目(No.2016YFC1301900)。

摘　　要：目的研究大动脉转位(TGA)患儿行一期大动脉调转术(ASO)后应用大剂量血管活性药物的有效性及安全性。方法选取2009年1月至2019年1月在中国人民解放军南部战区总医院心脏外科行ASO并术后使用血管活性药物的82例TGA患儿为研究对象,根据术后血管活性药物(肾上腺素和去甲肾上腺素)的使用剂量将其分为A组[20例,0.01~0.10μg/(kg·min)]、B组[32例,0.11~0.20μg/(kg·min)]及C组[30例,0.21~0.40μg/(kg·min)]。比较三组患儿的并发症发生情况、用药时间、手术时间、术后住院时间、体外循环时间及应用血管活性药后的不良反应发生情况。结果A、B、C组患儿早期死亡率分别为15.0%(3/20)、15.6%(5/32)、10.0%(3/30),差异无统计学意义(P>0.05)。三组患儿并发症总发生率、用药时间和手术时间比较,差异具有统计学意义(P<0.05),其中,C组的并发症总发生率最低。A、B、C组使用血管活性药物后分别有13、8、5例发生不良反应,三组低心排征、乳酸>4.0 mmol/L的发生率比较,差异具有统计学意义(P<0.05)。结论TGA患儿ASO术后早期死亡率仍较高;为维持患儿生命体征平稳,大剂量使用血管活性药物是安全、有效的,且未增加患儿的早期死亡率和术后并发症发生率。Objective To study the efficacy and safety of high-dose vasoactive drugs for children with transposition of great arteries(TGA)after one-stage arterial switch operation(ASO).Methods Eighty-two children with TGA who underwent ASO and used vasoactive drugs postoperatively in the cardiac surgery department of General hospital of southern theatre command of the Chinese People's Liberation Army from January 2009 to January 2019 were selected as the research objects and divided into group A[20 cases,0.01-0.10μg/(kg·min)],group B[32 cases,0.11-0.20μg/(kg·min)],and group C[30 cases,0.21-0.40μg/(kg·min)]according to the dosage of vasoactive drugs(epinephrine and norepinephrine).The complications,medication time,operation time,postoperative hospital stay,cardiopulmonary bypass time and adverse reactions after application of vasoactive drugs were compared among the three groups.Results The early mortality rates of the groups A,B and C were 15.0%(3/20),15.6%(5/32)and 10.0%(3/30),respectively,with no significant difference(P>0.05).There were significant differences in the total incidence of complications,medication time and operation time among the three groups(P<0.05),and the total incidence of complications in the group C was the lowest among them.Adverse reactions occurred in 13,8 and 5 cases in the groups A,B and C after using vasoactive drugs,respectively.There were significant differences in the incidences of low cardiac output and lactic acid>4.0 mmol/L among the three groups(P<0.05).Conclusion The early mortality of TGA children after ASO is still high;high-dose vasoactive drugs is safe and effective to maintain the stability of vital signs,and does not increase the early mortality and postoperative complications.

关 键 词：大动脉转位 大动脉调转术 血管活性药物 肾上腺素 去甲肾上腺素 

分 类 号：R654.2[医药卫生—外科学]