论文部分内容阅读
目的总结分析采用心房动脉双调转(DS)术治疗小儿先天性矫正型大动脉转位(ccTGA)的围术期管理经验。方法 2004年1月-2009年12月北京阜外心血管病医院共实施DS手术26例,全部为ccTGA患儿。患儿平均年龄为3.0岁(0.5～10.0岁),平均体质量13.0kg(5.0～24.5kg)。根据手术方式,将患儿分为2组,比较围术期管理的特点。16例直接Ⅰ期行DS手术,即主动脉与肺动脉调转术和左心房与右心房转流术(Ⅰ组)。10例为分期手术,先行左心室功能锻炼手术(即肺动脉环缩术),择期再行DS手术(Ⅱ组)。结果Ⅰ组患儿体外循环(CPB)时间和主动脉阻断(AO)时间分别为(343.3±51.5)min和(232.3±56.6)min,Ⅱ组分别为(321.5±88.8)min和(192.1±11.7)min。Ⅰ组患儿无死亡,但发生右心功能衰竭(4例,25%)和心律失常(12例,75%)的概率较高。1例使用CPB膜肺氧合器(ECMO)进行右心功能辅助,7d后成功脱机。Ⅱ组患儿死亡4例(40%),均为左心衰竭死亡,其中3例使用ECMO进行左心功能辅助,1例未能脱机。结论采用DS术Ⅰ期治疗小儿ccTGA,术中右心功能异常多见,应主要预防和治疗肺动脉高压,降低右心后负荷。分期DS术治疗小儿ccTGA应注意降低左心后负荷,避免左心室做功突然增加。ECMO辅助循环可促进心脏功能恢复。
Objective To summarize and analyze the perioperative management experience of atrial tachycardia transposition (DS) in the treatment of pediatric congenital aortic transposition (ccTGA). Methods From January 2004 to December 2009, Beijing Fuwai Hospital for Cardiovascular Surgery performed a total of 26 DS operations, all of whom were children with ccTGA. Children with an average age of 3.0 years (0.5 to 10.0 years), the average body mass 13.0kg (5.0 ~ 24.5kg). According to the surgical approach, the children were divided into two groups, comparing the characteristics of perioperative management. Sixteen patients underwent DS surgery directly, ie, aortic and pulmonary arterial switch and left atrium and right atrium bypass (group Ⅰ). Ten patients underwent staged surgery, first left ventricular functional exercise surgery (ie, pulmonary artery systole), and elective DS surgery (group Ⅱ). Results The CPB time and the aorta occlusion time were (343.3 ± 51.5) min and (232.3 ± 56.6) min in group Ⅰ, (321.5 ± 88.8) min and (192.1 ± 11.7) min. There was no death in group I, but the probability of having right heart failure (4 cases, 25%) and arrhythmia (12 cases, 75%) was high. 1 case of CPB membrane oxygenator (ECMO) for right heart function aided 7 days after the success of offline. There were 4 deaths in group Ⅱ (40%), all of them died of left heart failure. Three of them were assisted by left ventricular function with ECMO, and 1 failed to go offline. Conclusions The primary treatment of pediatric ccTGA with DS stage Ⅰ is more common in patients with abnormal right heart function. Pulmonary hypertension should be mainly prevented and treated, and the post-right heart load should be reduced. Staging DS surgery in children with ccTGA should pay attention to reduce left ventricular load, to avoid a sudden increase in left ventricular work. ECMO Auxiliary circulation promotes cardiac recovery.