主动脉缩窄患儿非体外循环下行主动脉缩窄矫治术疗效观察  

Repair of coarctation of the aorta under non-extracorporeal circulation in children

作　　者：吴在强 范太兵[2] 张浩 魏志潘 张岩伟 WU Zai-qiang;FAN Tai-bing;ZHANG Hao;WEI Zhi-pan;ZHANG Yan-wei(Department of Pediatric Heart Surgery,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Heart Center,Henan Provincial People's Hospital»Department of Pediatric Heart Surgery,Central China Fuzuai Hospital,Zhengzhou,Henan 451464,China;Pediatric Heart Center,Shanghai Childrenrs Medical Center,Shanghai 200127,China)

机构地区：[1]河南大学人民医院河南省人民医院小儿心脏外科,河南郑州450003 [2]河南省人民医院心脏中心,华中阜外医院小儿心脏外科,河南郑州451464 [3]上海儿童医学中心小儿心脏中心,上海200127

出　　处：《中华实用诊断与治疗杂志》2021年第6期552-555,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关项目(201702184)。

摘　　要：目的探讨主动脉缩窄(coarctation of the aorta,COA)矫治术在非体外循环下治疗COA患儿的效果及术后并发症发生情况。方法COA患儿30例,其中10例合并动脉导管未闭,4例合并房间隔缺损或卵圆孔未闭,2例合并室间隔缺损,2例合并二尖瓣关闭不全,3例合并主动脉弓发育不良,均在非体外循环下行COA矫治术治疗。观察患儿术后并发症发生情况,随访4~40个月,比较患儿术前与出院前上下肢收缩压差、COA段压差、COA段血流速度及末次随访时与出院前COA段压差、COA段血流速度。根据患儿年龄分为<1岁组19例与1~6岁组11例,比较2组临床资料,术前及出院前上下肢收缩压差、COA段压差、COA段血流速度,末次随访时COA段压差、末次随访时COA段血流速度。结果手术均在非体外循环下完成,10例合并动脉导管未闭患儿术中闭合动脉导管,3例合并主动脉弓发育不良患儿术中应用Gore-Tex补片或牛心包补片扩大修补主动脉,4例合并房间隔缺损或卵圆孔未闭、2例合并室间隔缺损、2例合并二尖瓣关闭不全的患儿,因缺损小,有自愈可能或对患儿心功能暂无影响,未行缺损修补手术治疗。患儿出院前上下肢收缩压差[(9.90±8.81)mm Hg]、COA段压差[(18.37±6.98)mm Hg]、COA段血流速度[(2.89±4.38)m/s]均低于术前[(41.70±9.34)mm Hg、(55.47±16.70)mm Hg、(3.71±0.58)m/s](P<0.05),末次随访时COA段压差[(20.03±10.54)mm Hg]、COA段血流速度[(2.17±0.51)m/s]与出院前比较差异均无统计学意义(P>0.05)。<1岁组患儿主动脉阻断时间[(23.21±7.34)min]短于1~6岁组[(27.41±12.35)min](P<0.05),呼吸机辅助时间[17.24(7.18,36.09)h]、ICU治疗时间[79.25(45.25,158.63)h]均长于1~6岁组[4.50(2.80,9.67)h,22.50(18.00,51.00)h](P<0.05),2组手术时间,术前及出院前上下肢收缩压差、COA段压差、COA段血液流速,末次随访时COA段压差、COA段血流速度比较差异均无统计学意义(P>0.05)。住院及随访期间无死亡�Objective To investigate the clinical outcome and postoperative complications of repair of coarctation of the aorta(COA)under non-extracorporeal circulation in children.Methods In 30 children with COA,10 children were complicated with patent ductus arteriosus,4 were complicated with atrial septal defect or patent foramen ovale,2 were complicated with ventricular septal defect,2 were complicated with mitral regurgitation and 3 were complicated with aortic arch dysplasia.All children were performed repair of COA under non-extracorporeal circulation.The patients were followed up for 4 to 40 months and the postoperative complications were observed.The radial-femoral arterial systolic pressure difference,COA segment pressure difference and COA segment blood flow velocity before operation and discharge,as well as the COA segment pressure difference and COA segment blood flow velocity before discharge and at the final follow-up were compared.The children were divided into<1 year old group and 1 to 6 years old group.The clinical data,radial-femoral arterial systolic pressure difference,COA segment pressure difference and COA segment blood flow velocity before operation and discharge,as well as the COA segment pressure difference and COA segment blood flow velocity at the final follow-up were compared between two groups.Results All operations were completed under non-extracorporeal circulation.Patent ductus arteriosus was closed in 10 children during operation,aortic arch dysplasia was repaired with Gore-Tex patch or bovine pericardial patch in 3,while atrial septal defect or patent foramen ovale in 4,ventricular septal defect in 2 and mitral regurgitation in 2 were not repaired because of the possibility of self-healing or no influence on cardiac function due to minor defect.The radial-femoral arterial systolic pressure difference((9.90±8.81)mm Hg),COA segment pressure difference((18.37±6.98)mm Hg),and COA segment blood flow velocity((2.89±4.38)m/s)before discharge were lower than those before operation((41.70±9.34)m

关 键 词：主动脉缩窄 主动脉缩窄矫治术 非体外循环 

分 类 号：R726.5[医药卫生—儿科]