139例婴儿法乐四联症根治术经验总结  

Experience of Total Repair for Tetralogy 139 Cases of Fallot in Infancy

作　　者：郭岩[1] 沈向东[1] 刘迎龙[1] 闫军[1] 李守军[1] 吴清玉[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京市100037

出　　处：《中国循环杂志》2003年第6期446-448,共3页Chinese Circulation Journal

摘　　要：目的 :总结我院近 3年完成的 13 9例婴儿法乐四联症根治术的临床经验。方法 :2 0 0 0年 1月至 2 0 0 2年 12月 ,我院共完成婴儿法乐四联症根治术 13 9例 ,男 9例 ,女 46例 ,年龄 3～ 12 (8.3±2 .4)个月 ,体重 4.5～ 11.0 (8.1± 1.4)kg。除外 1例经右心房一肺动脉切口完成右心室流出道疏通 ,其余全部经右心室流出道切口完成疏通。结果 :全组 13 9例婴儿法乐四联症根治术成功 13 4例 ,死亡 5例 ,手术早期死亡率 3 .6%。死亡原因 :严重低心排综合征 4例 ,急性呼吸窘迫综合征 1例。 16例发生了较严重的并发症 ,包括二次气管插管 10例 ,感染 9例 ,急性呼吸窘迫综合征 7例 ,急性肾功能衰竭需腹膜透析治疗 7例 ,低心排综合征 5例 ,脑损害 4例 ,其他 4例。结论 :在婴儿期进行TOF根治术同样可以取得满意的临床结果。呼吸系统并发症是婴儿法乐四联症根治术后面临的主要问题之一。Objective:To review the experience of total repair for Tetralogy of Fallot (TOF) in infancy.Methods:Between January 2000 and December 2002,139 infants (male 93,female 46) underwent total repair of TOF. The infants were aged from 3 to 12 (mean 8.3±2.4)months,and weighted from 4.5 to 11.0 (mean 8.1 + 1.4)kg. All pro cedures were completed using cardiopulmonary bypass (CPB) with a transventricular approach,except one with a transatrial transpulmonary approach. Transannular patches were used in 96 cases,among them monocusps were used in 13 cases.Results:The crossclamp time was 30 to 140 (mean 63±15)mins,the duration of CPB was from 60 to 214 (mean 94±24)mins. Five infants died after operation,from of low cardiac output syndrome (LOS) ( n = 4) in 4,and acute respiratory distress syndrome (ARDS) (n = 1). The mortality was 3.6% . Other sixteen infants suffered from severe complications,in cluding reintubation (n = 10),infection (n = 9),ARDS (n = 7),acute renal failure (n = 7),LOS (n = 5),neuropsychologic complication ( n = 4) ,residual stenosis ( n = 2) and leakage ( n = 2) .Conclusion:The results of total repair for TOF in infancy are satisfactory. The mortality is similar to that of patients older than 1 year. ARDS is still one of the most common complications we should deal with.

关 键 词：婴儿 法乐四联症 根治术 临床经验 手术治疗 

分 类 号：R726.542[医药卫生—儿科]