外科手术治疗主动脉缩窄合并复杂心脏畸形79例单中心回顾性分析  

Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies:A retrospective analysis in a single center

作　　者：刘湘 韦慧锦 马力[1,2] 邹明晖 陈伟丹[1,2] 陈欣欣 LIU Xiang;WEI Huijin;MA Li;ZOU Minghui;CHEN Weidan;CHEN Xinxin(Heart Center,Guangzhou Women and Children’s Medical Center,Guangzhou Medical University,Guangzhou,510623,P.R.China;Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease,Guangzhou,510623,P.R.China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心心脏中心,广州510623 [2]广东省结构性出生缺陷疾病研究重点实验室,广州510623

出　　处：《中国胸心血管外科临床杂志》2022年第11期1466-1471,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广州市妇女儿童医疗中心/儿科研究所内部科研基金(YIP-2018-026)。

摘　　要：目的总结主动脉缩窄合并复杂心脏畸形的手术治疗效果。方法回顾性分析2010年1月19日—2017年9月7日于广州市妇女儿童医疗中心住院治疗的主动脉缩窄合并复杂心脏畸形79例患儿的临床资料,其中男52例、女27例,中位年龄71 d,中位体重4.3 kg。术前合并气管狭窄26例,术前气管插管7例。采取胸骨正中切口入路,以扩大端侧吻合矫治主动脉缩窄,同期处理合并心脏畸形。所有手术由同一组外科医师完成。结果中位深低温停循环时间18(13~28)min,中位主动脉阻断时间62(15~199)min,中位体外循环时间145(71~674)min;中位术后机械通气时间72(9~960)h,中位ICU滞留时间144(12~1944)h,中位总住院时间24(2~93)d;早期死亡9例,晚期死亡5例;再手术28例,再缩窄10例。主动脉缩窄段压差在术后明显下降;经皮血氧饱和度、C-反应蛋白(CRP)、乳酸和肌酐水平在术后明显上升。与非死亡组相比,死亡组的术前和术后即刻血氧饱和度均较低,而术后即刻脑钠肽(BNP)和CRP均较高。结论胸骨正中单一切口下,以扩大端侧吻合法矫治主动脉缩窄,同期处理合并心脏畸形,取得良好的近中期效果。应加强围术期管理,通过改善氧合、限制BNP和CRP水平,有望降低病死率。Objective To summarize the results of surgical treatment for 79 patients with coarctation of the aorta(CoA)combined with complex anomalies(CA)in recent years.Methods The data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children’s Medical Center between January 19,2010 and September 7,2017were collected and analyzed.There were 52 males and 27 females.The median age was 71 days,and the median weight was4.3 kg.There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation.Extended end-to-side anastomosis was used to correct the CoA,and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy.All operations were performed by the same group of surgeons.Results The median deep hypothermic circulatory arrest was 18(13-28)minutes,the median aorta cross-clamp time was62(15-199)minutes,the median cardiopulmonary bypass time was 145(71-674)minutes,the median ventilation time was72(9-960)hours,the median length of ICU stay was 144(12-1944)hours,and the median length of hospital stay was24(2-93)days.Early death occurred in 9 patients and late death occurred in 5 patients.Reoperation occurred in 28patients and recoarctation developed in 10 patients.After operation,transcoarctation gradient was reduced,and the transcutaneous oxygen saturation,C-reactive protein(CRP),lactate and creatinine were increased.Compared to the survival group,both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide(BNP)and CRP were higher in the death group.Conclusion Correcting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe,and the outcomes of immediate and medial-term are satisfactory.Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.

关 键 词：先天性心脏病 主动脉缩窄 复杂心脏畸形 外科手术 疗效 

分 类 号：R726.5[医药卫生—儿科]