高原地区婴幼儿完全型房室间隔缺损的外科处理策略及随访结果  

Surgical management of infant-patients with complete atrioventricular septal defect complicated with pulmonary artery hypertension at high altitude

作　　者：邬晓臣 王舰 刘建 何思毅 蒋利 刘顺碧 张近宝 WU Xiao-chen;WANG Jian;LIU Jian;HE Si-yi;JIANG Li;Liu Shun-bi;ZHANG Jin-bao(Department of Cardiothoracic Surgery,General Hospital,Western Theater Command,Chengdu 610083,Sichuan,China)

机构地区：[1]解放军西部战区总医院心血管外科,四川成都610083

出　　处：《心脏杂志》2024年第1期50-53,58,共5页Chinese Heart Journal

基　　金：国家重点研发计划项目(2016YFC1301901)。

摘　　要：目的 评估高原地区婴幼儿合并肺动脉高压(PAH)完全型房室间隔缺损(cAVSD)患儿的外科处理策略及随访结果。方法 选择2009年12月~2021年12月期间28例2岁以下cAVSD合并PAH的患儿进行一期矫治,其中男15例,女13例,年龄(2.5~21.0)月,体质量(2.5~11.0)kg,其中合并中度及以上肺动脉高压患者15例,设为A组。合并轻度及正常肺动脉压患者13例,设为B组。对两组患者的ICU住院时间、呼吸机带管时间、主动脉阻闭时间、整体住院时间、死亡率等指标进行对比,并进行随访。术中采用改良单片法3例,双片法25例,术中直接缝合左侧房室瓣瓣裂孔17例,裂孔补片加宽及腱索移植1例,行左房室瓣后瓣瓣环成形3例。结果 两组患儿的年龄、体质量、Rastelli分型、唐氏综合征、共同瓣返流和室间隔缺损大小数据值均无统计学差异。与B组比较,A组患儿呼吸机带管时间明显变长(P<0.05),其他指标如ICU住院时间、整体住院时间、主动脉阻闭时间和病死率均无明显差异。与A组比较,B组轻度左侧房室瓣返流比例较低(P<0.05),其余项目室间隔残余分流、中重度左侧房室瓣返流、右侧房室瓣返流、完全性房室传导阻滞与术后早期死亡均无明显差异。术后随访所有患儿的随访时间为(8±3)年,心脏超声心动图随访统计结果为:二尖瓣关闭不全轻度18例、中度5例、重度2例,三尖瓣轻度关闭不全19例、中度4例、重度2例,2例重度二尖瓣关闭不全患者均接受再次瓣膜修复/置换术,全组存活病例均无左室流出道狭窄,三尖瓣重度反流1例、中度反流2例。A组的三例死亡病例根据患者在监护室最后一次超声评估结果为二尖瓣重度反流1例、中度反流1例、轻度反流1例。结论 高原地区的婴幼儿完全性房室间隔缺损患儿,其肺血管病变早、肺动脉高压进展快,应尽早进行手术治疗,手术成功的关键是避免三度房室传导阻滞及瓣膜成�AIM To evaluate the surgical management strategy and follow-up of complete atrioventricular septal defect(cAVSD)infant-patients complicated with pulmonary artery hypertension(PAH)at high altitude.METHODS 28 children under 2 years old with cAVSD and PAH were selected for primary correction from December 2009 to December 2021,including 15 males and 13 females,aged(2.5~21)months,with a body mass of(2.5~11.0)kg.Among them,15 patients with moderate or above pulmonary hypertension were included in Group A.Thirteen patients with mild and normal pulmonary arterial pressure were assigned to Group B.Compare the ICU hospitalization time,ventilator intubation time,aortic occlusion time,overall hospitalization time,and mortality rate between the two groups of patients.And conduct follow-up.During the operation,improved single slice method was used in 3 cases,double slice method in 25 cases,direct suture of left atrioventricular valve holes was performed in 17 cases,hole patch widening and tendon cord transplantation was performed in 1 case,and left atrioventricular valve posterior annulus reconstruction was performed in 3 cases.RESULTS There was no statistical difference in age,body mass,Rastelli classification,Down syndrome,common valve regurgitation and ventricular septal defect size between the two groups.Compared with Group B,the duration of ventilator intubation in Group A was significantly longer(P<0.05),while there were no significant differences in other indicators such as ICU hospitalization time,overall hospitalization time,aortic occlusion time,and mortality rate.Compared with Group A,Group B had a lower proportion of mild left atrioventricular valve regurgitation(P<0.05),while there were no significant differences in residual ventricular septal shunt,moderate to severe left atrioventricular valve regurgitation,right atrioventricular valve regurgitation,complete atrioventricular block,and early postoperative death in other items.The follow-up time of all children after surgery was(8±3)years.The statistical results

关 键 词：高原 完全型房室隔缺损 肺动脉高压 左侧房室瓣 

分 类 号：R541.1[医药卫生—心血管疾病]