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目的通过对肺动脉闭锁合并室间隔缺损(PA/VSD)行体-肺动脉分流或右心室肺动脉连接术后早期效果进行比较,探讨这两种姑息手术早期处理的效果及特点。方法回顾性分析阜外心血管病医院2009年1月至2011年12月所有接受体-肺动脉分流或右心室肺动脉连接术治疗PA/VSD的89例患者的临床资料,根据手术术式不同,将89例患儿分为两组,体-肺动脉分流组:59例,男35、女24,中位年龄25个月(4个月至8岁);右心室肺动脉连接组:30例,男19例、女11例,中位年龄24个月(28 d至7岁2个月)。对两组患儿术后早期的各项临床指标(术后呼吸机辅助呼吸时间、ICU停留时间、并发症发生、二次手术、血氧饱和度改善、死亡率)进行比较,分析其术后效果。结果体-肺动脉分流组59例患儿术后早期院内死亡3例,住院死亡率为5.1%;右心室肺动脉连接组30例患儿术后早期无死亡。右心室肺动脉连接组氧合改善程度明显高于体-肺动脉分流组(31.7%vs.22.2%,P<0.05)。体-肺动脉分流组和右心室肺动脉连接组术后ICU停留时间分别为(3.6±2.5)d和(4.2±5.1)d(P>0.05);呼吸机辅助呼吸时间分别为(34.8±33.5)h和(44.3±39.6)h(P>0.05);术后并发症的发生率为37.3%和30.0%(P>0.05);二次开胸手术率为15.3%和6.7%(P>0.05);严重并发症发生率为25.4%和6.7%(P<0.05)。结论右心室肺动脉连接术患者能更平稳地渡过围手术期,术后氧合情况改善更明显,死亡率较低。术后中远期效果有待进一步评价,大样本的病例资料有待进一步积累。
Objective To compare the early effects of pulmonary artery bypass grafting and ventricular septal defect (PA / VSD) after systemic-pulmonary shunt or right ventricular pulmonary artery connection to explore the effect and characteristics of early treatment of these two palliative surgery. Methods The clinical data of 89 patients with PA / VSD in all recipients from January 2009 to December 2011 in Fu Wai Hospital were retrospectively analyzed. According to the different surgical procedures, Eighty-nine children were divided into two groups. The body-pulmonary shunt group consisted of 59 patients with 35 males and 24 females with a median age of 25 months (range, 4 months to 8 years). In the right ventricular pulmonary artery group, 30 Cases, female 11 cases, the median age of 24 months (28 d to 7 years 2 months). The clinical indexes (postoperative ventilator assisted breathing time, ICU stay time, complications, secondary surgery, oxygen saturation improvement, and mortality) of the two groups were compared at the early postoperative period, and the postoperative effect. Results In the body-pulmonary shunt group, 59 cases of early postoperative hospital mortality were found in 3 cases, and the in-hospital mortality rate was 5.1%. In the right ventricular pulmonary artery connection group, 30 cases had no death in the early postoperative period. Right ventricular pulmonary artery connection oxygenation improved significantly higher than the body - pulmonary bypass group (31.7% vs.22.2%, P <0.05). The duration of ICU stay in the group of pulmonary artery shunt and right ventricle pulmonary artery were (3.6 ± 2.5) d and (4.2 ± 5.1) d, respectively (P> 0.05). The duration of ventilator assisted breathing was (34.8 ± 33.5) h And (44.3 ± 39.6) h respectively (P> 0.05). The incidences of postoperative complications were 37.3% and 30.0% (P> 0.05). The rates of secondary thoracotomy were 15.3% and 6.7%, respectively. Serious complication rates were 25.4% and 6.7% (P <0.05). Conclusion Patients with right ventricular pulmonary artery bypass surgery can be more smoothly perioperative period, postoperative oxygenation improved more obviously, the mortality rate is lower. The long-term postoperative effect needs further evaluation, large sample data to be further accumulated.