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目的 :总结完全性大动脉转位 (D TGA)行大动脉调转 (Switch)术后早期处理的经验。方法 :对 5例患儿在深低温、低流量和深低温停循环下施行Switch术。术后严密监测血流动力学指标 ,及时补充胶体溶液 ,维持适当的呼吸性碱中毒 ,应用正性肌力药物及降低肺血管阻力药物。结果 :全组手术无死亡。术后早期并发症包括低心排血量综合征 1例 ,房性心动过速 2例 ,低氧血症 2例 ,肺不张 2例 ,肺部感染 1例 ,胸腔引流管留置时间 >2周 1例 ,右心室流出道阻塞 1例。结论 :术后维持足够前负荷 ,积极采取有效降低肺循环阻力及左心房压力的治疗措施 ,及时纠治低心排血量综合征、心律失常、低氧血症等并发症 ,可有效提高手术成功率。
Objective: To summarize the experience of early postoperative management of aortic transposition after complete transposition of the great arteries (D TGA). METHODS: Five patients underwent Switch surgery under deep hypothermia, low flow and deep hypothermic circulatory arrest. Follow-up monitoring of hemodynamic indicators, timely replenishment of colloidal solution, to maintain appropriate respiratory alkalosis, the application of inotropic drugs and lower pulmonary vascular resistance drugs. Results: There was no death in the whole operation. Early postoperative complications include low cardiac output syndrome in 1 case, atrial tachycardia in 2 cases, hypoxemia in 2 cases, atelectasis in 2 cases, pulmonary infection in 1 case, chest drainage tube retention time> 2 Week 1 case, right ventricular outflow tract obstruction in 1 case. Conclusions: After the operation, sufficient pre-load is maintained and the treatment measures that effectively reduce pulmonary resistance and left atrial pressure are taken actively to correct the complications such as low cardiac output syndrome, arrhythmia and hypoxemia in a timely manner, which can effectively improve the operation success rate.