Fontan手术Y型心外管道与传统心外管道术后血流动力学对比研究  

Comparative study of hemodynamics between Y-shaped and traditional extracardiac conduit Fontan operation

作　　者：张春振 方敏华 金岩 张永 吕丽华 Zhang Chunzhen;Fang Minhua;Jin Yan;Zhang Yong;Lv Lihua(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管外科,沈阳110016

出　　处：《中国体外循环杂志》2021年第1期31-33,共3页Chinese Journal of Extracorporeal Circulation

基　　金：2016年国家科技重大专项课题(2016YF1301905)。

摘　　要：目的通过随访研究,对比Fontan手术Y型心外管道(YECFO)与传统心外管道(TECFO)术后血流动力学结果,评价YECFO手术疗效。方法收集2014年至2017年本院心外管道Fontan手术后患者12例,其中女性5例,男性7例;平均(6.6±2.4)岁,平均随访(2.7±1.3)年。YECFO 6例,TECFO 6例,术后早期对比体外循环时间、呼吸辅助时间及ICU滞留时间。随访全组均行超声心动图、CT三维重建、核素肺血灌注扫描等检查。结果全组早期无死亡或Fontan手术拆除。YECFO手术体外循环、主动脉阻断时间较TECFO长(P<0.05),术后呼吸辅助、ICU滞留时间无明显差异。随访超声、CT三维重建指标未见明显差异。下腔静脉核素造影显示YECFO血流明显优于TECFO(P<0.01)。结论YECFO、TECFO术后早期血流动力学均良好,临床疗效无差异。YECFO手术后肺血分布更合理,主要体现在下腔静脉至左、右肺血分布更接近生理状态。Objective To evaluate the efficacy of Y-type extracardiac conduit Fontan operation(YECFO)by comparing the hemodynamic results after the YECFO and traditional extracardiac conduit Fontan operation(TECFO).Methods From 2014 to 2017,12 patients(5 females,7 males)underwent extracardiac conduit Fontan operation(6 YECFO,6 TECFO)in our hospital were collected,with an average age of 6.6±2.4 years and an average follow-up time of 2.7±1.3 years.The time of cardiopulmonary bypass(CPB),mechanical ventilation and ICU stay were compared in the early postoperative period.All patients were examined by echocardiography,three-dimensional CT reconstruction and pulmonary blood perfusion scan.Results There was no early death or surgical intervention after Fontan operation in the whole group.The CPB and aortic cross-clamping time were significantly longer in YECFO group(P<0.05).The time of mechanical ventilation and ICU stay were not significantly different between the two groups.There was no significant difference in follow-up echocardiography and three-dimensional CT reconstruction between the two groups.The blood flow of YECFO examined by inferior vena cava(IVC)radionuclide angiography was significantly better than that of TECFO(P<0.01).Conclusion The early hemodynamic parameters of YECFO and TECFO were stable and there was no significant difference in clinical efficacy.The distribution of pulmonary blood was more reasonable in YECFO group,mainly reflected in the physiological state of the blood distribution from IVC to left and right pulmonary.

关 键 词：FONTAN手术 先天性心脏病 随访 心肺转流 心脏手术 

分 类 号：R726.5[医药卫生—儿科]