体肺分流-分期手术在婴幼儿肺动脉发育不良型法洛四联症的应用  

The application of stemic-pulmonary shunt in staged operation for tetralogy of Fallot with hypoplasia pulmonary arteries

作　　者：刘爱军[1] 李斌[1] 杨明[1] 范祥明[1] 刘承虎[1] 程沛[1] 苏俊武[1] Liu Aijun;Li Bin;Yang Ming;Fan Xiangming;Liu Chenghu;Cheng Pei;Su Junwu(Department of the Pediatric Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏外科,北京市心肺血管疾病研究所,100029

出　　处：《中华胸心血管外科杂志》2021年第7期394-398,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：科技部国家重点研发计划(2020YFC1107903)。

摘　　要：目的:比较体肺分流-分期手术对肺动脉发育不良型法洛四联症(TOF)治疗效果。方法:2010年1月至2015年12月共完成949例3岁以下TOF矫治手术,男546例,女403例;平均年龄13个月,平均体质量9.4 kg。一期矫治手术853例(根治手术组),体肺分流手术96例(体肺分流组)。比较两组患儿手术性别、年龄、体质量、经皮血氧饱和度(SPO_(2));术前临床症状;术前和术后主肺动脉直径、McGoon比值、NAKATA指数、肺动脉环Z值、左心室舒张期末径等指标。结果:全组患儿术后早期死亡28例(3.0%),根治手术组死亡比例(2.9%)与体肺分流组(3.1%)差异无统计学意义。体肺分流组患儿手术年龄[(0.95±0.56)岁对(1.09±0.59)岁]和体质量[(8.6±1.8)kg对(9.5±2.1)kg]均明显低于根治手术组;体肺分流组较根治手术组更易出现缺氧发作等临床症状(30.2%对19.7%);且SPO_(2)体肺分流组较根治手术组显著降低(0.75±0.09对0.85±0.09)。体肺分流组患儿较根治手术组肺动脉发育更差,体肺分流组McGoon比值(1.4±0.3对1.9±0.5)、Nakata指数[(124±43)mm^(2) /m^(2) 对(222±88)mm^(2) /m^(2) ]和肺动脉环Z值(-4.3±2.6对-2.3±2.1)均显著低于根治手术组。但是体肺分流组较根治手术组在术后呼吸机辅助上差异无统计学意义。与体肺分流术前相比较,分流术后SPO_(2)由术前的0.75上升至0.83;主肺动脉直径由6.4 mm增至9.2 mm,McGoon比值由1.42增至1.83,Nakata指数由126.4 mm^(2) /m^(2) 增至212.6 mm^(2) /m^(2) ,肺动脉瓣环Z值由术前-4.3增至-2.4;分流术后左心室舒张期末径也由术前的21.2 mm增至24.5 mm。结论:对缺氧症状明显、肺动脉发育不良的小婴儿,体肺分流-分期手术安全、有效,不增加手术死亡。体肺分流可以显著改善氧和,提高根治手术年龄;还可以显著促进肺动脉及左心室的发育,降低跨环率。Objective The study aimed to evaluate the effect of systemic-pulmonary shunt(SPS)on the infants with tetralogy of Fallot(TOF)with hypoplasia pulmonary arteries.Methods Among 949 infants less than three-year-old who underwent surgical intervention between January 2010 and December 2015,853 infants underwent one-stage primary repair(groupⅠ),whereas 96 infants underwent SPS(groupⅡ).Among them,546 were males and 403 were females.The average age and average weight at operation were 13 months and 9.4 kg,respectively.20.8%infants had clinical symptoms before operation.Perioperative and follow-up parameters were assessed including age,weight,sex,transcutaneous oxygen saturation(SPO_(2)),preoperative clinic symptom,ratio of McGoon,NAKATA index,Z score of pulmonary annulus,left ventricular end diastolic diameter(LVEDD).Results There were 28(3.0%)early postoperative deaths in the whole group.And no significant difference in mortality was found between groupⅠ(2.9%)and groupⅡ(3.1%).Compared with groupⅠ,age and weight were significantly lower in patients in groupⅡ[(0.95±0.56)years old vs.(1.09±0.59)years old]and[(8.6±1.8)kg vs.(9.5±2.1)kg],respectively.Patients in groupⅡhad a lower SPO_(2)(0.75±0.09 vs.0.85±0.09)and was more prone to appear hypoxic spell(30.2%vs.19.7%)than patients in groupⅠ.Patients in groupⅡhad a more poor development in pulmonary artery.The ratio of McGoon,NAKATA index and Z score of pulmonary annulus in groupⅡwere significantly less than that in groupⅠ[1.4±0.3 vs.1.9±0.5,(124±43)mm^(2)/m^(2) vs.(222±88)mm^(2)/m^(2) and-4.3±2.6 vs.-2.3±2.1],respectively.There was no difference of extubation time bewteen two groups.SPO_(2) rose significantly from 0.75 to 0.83 after SPS.And after SPS,the diameter of main pulmonary artery,the ratio of McGoon,NAKATA index and Z score of pulmonary annulus increased significantly from 6.4 mm,1.42,126.4 mm^(2)/m^(2) and-4.3 to 9.2 mm,1.83,212.6 mm^(2)/m^(2) and-2.4,respectively.Moreover,LVEDD also increased significantly from 21.2 mm to 24.5 mm af

关 键 词：法洛四联症 体肺分流 分期手术 

分 类 号：R726.5[医药卫生—儿科]