急诊介入治疗在肺血减少型复杂先天性心脏病外科术后的应用  

Emergency interventional treatments in complex congenital heart diseases with diminished pulmonary blood after surgical procedures

作　　者：王霄芳[1] 顾燕[1] 姜小坤 梁永梅[1] 郭保静[1] 金梅[1] WANG Xiaofang;GU Yan;JIANG Xiaokun;LIANG Yongmei;GUO Baojing;JIN Mei(Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

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

出　　处：《心肺血管病杂志》2024年第4期366-371,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨急诊介入治疗在复杂先天性心脏病术后的应用经验。方法:收集我中心2013年1月至2023年5月,复杂先天性心脏病外科术后行急诊介入治疗的病例,分析基线资料、侧枝封堵前后的临床特点,外科术后侧枝分布、处理及临床转归。结果:共有12例肺血减少型复杂先天性心脏病术后因体肺侧枝行急诊介入治疗,其中男8例(66.7%)、女4例(33.3%);外科矫治手术中位年龄48(7.5, 93.0)个月,体质量13(6.9, 31.1)kg。其中10例术前行造影检查,有6例于外科术前行体肺侧枝封堵术,4例未见明显体肺侧枝或因体肺侧枝细小未封堵。所有患儿均行外科矫治术。7例患儿在外科术中有回血增多现象,2例在术中行体肺侧枝结扎。所有患儿因术后至少出现下述表现之一:不同程度的肺出血、血痰;需较高条件的呼吸机支持,呼吸末气道压高;影像学改变(胸X线片提示肺血多、肺部渗出或斑片影);无法拔除气管插管或拔管后不耐受;可伴有心功能不全及血氧饱和度维持不佳。所有患儿于外科矫治术后平均4.5(3.0,13.0)d行急诊体肺侧枝介入封堵术,共封堵体肺侧枝29支,平均每例患儿封堵侧枝2.4支。体肺侧枝主要源于胸主动脉(8例,66.7%)、头臂干动脉(8例,66.7%)及腹主动脉(2例,16.7%)。10患儿侧枝封堵术后病情改善:侧枝封堵后(55.8±30.4)h脱离呼吸机;且循环趋于平稳,心功能好转,顺利出院。另外2例因同时合并其他复杂情况,预后不良。结论:复杂多变的体肺侧枝循环是肺血减少型复杂先天性心脏病患儿的诊治难点之一,除了术前、术中早发现早干预,术后积极有效的急诊体肺侧枝封堵可作为补救措施,降低围术期并发症并改善围术期预后。Objective:To summarize and explore the role and application experience of emergency interventional therapy in the postoperative treatment of complex congenital heart disease.Methods:Data of patients(age<18 years)with post-operation emergency interventional treatment in complex congenital heart disease between January 2013 and May 2023 was retrospectively collected.SPSS 25.0 was used to analyze the baseline data,clinical characteristics before and after collateral occlusion,distribution,management,and clinical outcomes of collateral branches after surgery.Results:A total of 12 cases were included,with 8 males(66.7%)and 4 females(33.3%).At the time of surgery,the age was 48(7.5,93)months and the weight was 13(6.9,31.1)kg.Among these patients,10 patients were undergone preoperative imaging examination or therapy,of which 6 patients were treated by transcatheter embolization of the pulmonary collateral,while the other 4 patients without obvious pulmonary collaterals were not intervened.All children underwent surgical correction,among whom 7 cases had increased blood return,and 2 cases underwent ligation of the aortopulmonary collateral arteries during surgery.All children had at least one of the following symptoms after surgery:(1)with various degrees of pulmonary hemorrhage or bloody sputum,(2)requiring higher-condition ventilator support,with high end-tidal airway pressure;(3)pulmonary image changes(chest radiograph suggests pulmonary blood flow,pulmonary exudation,or patchy shadow);(4)intolerance to ventilator withdrawal.(5)accompanied by cardiac insufficiency and unsatisfactory maintenance of blood oxygen saturation.A total of 29 aortopulmonary collateral arteries in all patients were emergently occluded on an average of 4.5(3.0,13.0)days after surgical correction,with an average of 2.42 collateral vessels per child.The sources of the collateral arteries were mainly from the thoracic aorta(8 cases,66.7%),the brachiocephalic arteries(8 cases,66.7%),and the abdominal aorta(2 cases,16.7%).Ten patients'condition impr

关 键 词：先天性心脏病 介入治疗 体肺侧枝 心脏外科手术 

分 类 号：R54[医药卫生—心血管疾病]