目的总结动脉转位术(ASO)围手术期监护的经验,为提高其疗效提供借鉴。方法回顾性分析2000年1月至2009年6月广东省人民医院收治的135例完全型大动脉转位(TGA)患者行ASO的临床资料,男110例,女25例;手术时日龄1~160 d(27.24±26.49 d),体重2.4~5.0 kg(3.52±0.66 kg)。室间隔完整61例,室间隔缺损74例。术前动态监测血乳酸水平,纠正心功能不全,对98例(72.59%)明显低氧血症患者给予持续静脉注射前列腺素E1[PGE1,2~200 ng/(kg.min)]。手术在低温体外循环下施行,同期矫治合并畸形。术后严密监测凝血指标、左心功能,以间歇指令通气+容量保证通气(SIMV+VG)模式进行呼吸支持。22例术后应用PGE1[4~20 ng/(kg.min)]。结果全组体外循环时间36~423 min(189.20±59.94 min),主动脉阻断时间0~219 min(120.07±31.09 min),118例术后即时血氧饱和度95%~100%。术后机械通气时间24~792 h(168.24±154.80 h),总住院时间1~89 d(30.31±17.21 d)。生存108例,死亡27例(20.00%),主要死亡原因为低心排血量综合征。2001~2003年病死率为50.00%,2004~2006年为36.36%,2007~2009年后为8.43%,明显下降(χ2=18.323,P<0.001)。术后并发症:感染30例(22.22%),肺不张35例(25.93%);心电图检查示:ST-T改变50例(37.04%),心律失常44例(32.59%);超声心动图提示:吻合口狭窄36例(26.67%),肺动脉狭窄33例(24.44%)。结论 ASO应用于TGA手术效果良好,除手术、麻醉操作外,术前维持内环境稳定、控制血乳酸水平,术后注意呼吸管理、维护左心功能是成功的关键。 Objective To summarize the experience of perioperative monitoring of arterial transposition (ASO) and provide references for improving its curative effect. Methods The clinical data of 135 patients with complete aortic transposition (TGA) from January 2000 to June 2009 in Guangdong Provincial People’s Hospital were retrospectively analyzed. There were 110 males and 25 females with a mean age of 1 ~ 160 d (27.24 ± 26.49 d), body weight 2.4 ~ 5.0 kg (3.52 ± 0.66 kg). Complete interventricular septum in 61 cases, 74 cases of ventricular septal defect. Preoperative dynamic monitoring of blood lactate levels to correct heart failure, 98 patients (72.59%) were significantly hypoxemic patients given continuous intravenous prostaglandin E1 [PGE1, 2 ~ 200 ng / (kg.min)]. Surgery under hypothermic cardiopulmonary bypass with correction of malformations over the same period. Thromboembolism, left ventricular function were monitored closely after operation, and respiration support was performed in SIMV + VG mode. Twenty-two patients were treated with PGE1 [4-20 ng / (kg · min)]. Results The duration of cardiopulmonary bypass was 36 ~ 423 min (189.20 ± 59.94 min), aortic blockade time was 0 ~ 219 min (120.07 ± 31.09 min), and postoperative immediate oxygen saturation was 95% -100%. The time of postoperative mechanical ventilation was 24 ~ 792 h (168.24 ± 154.80 h) and the total hospital stay was 1 ~ 89 d (30.31 ± 17.21 d). Survival in 108 cases, 27 patients died (20.00%), the main cause of death was low cardiac output syndrome. The case fatality rate was 50.00% from 2001 to 2003, 36.36% from 2004 to 2006, and 8.43% from 2007 to 2009 (χ2 = 18.323, P <0.001). Postoperative complications included infection in 30 cases (22.22%) and atelectasis in 35 cases (25.93%). Electrocardiogram showed that ST-T changed in 50 cases (37.04%) and arrhythmia in 44 cases (32.59% Tip: anastomotic stenosis in 36 cases (26.67%), pulmonary stenosis in 33 cases (24.44%). Conclusion The application of ASO in TGA is effective. In addition to the operation and anesthesia, it is important to succeed in maintaining the stable internal environment, controlling blood lactate level, paying attention to respiratory management and maintaining left ventricular function after operation.