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目的:观察6月龄以上患儿大动脉调转手术效果。方法:将2009-06-2012-07于我中心拟行大动脉调转手术的患儿按入院年龄分为两组:A组(<6个月,24例)和B组(≥6个月,18例)。观察两组手术效果,记录出院3个月随访心脏超声和并发症情况;比较两组患儿术中情况:手术时间、体外循环时间、心脏停搏时间和主动脉开放后心脏自动复跳情况;比较两组患儿循环功能指标:术中血液超滤完成后即时平均肺动脉压力(MPAP)、平均动脉压(MAP)、中心静脉压(CVP)和监护室内血管活性药物评分,观察手术前后患儿肺动脉压力改变情况;比较两组患儿监护室治疗情况:机械通气时间、监护室治疗时间、再次(多次)气管插管例数和肺部感染例数。结果:A组术后当日死亡2例,余临床治愈出院,其中12例术后3个月随访心脏超声提示心内畸形矫治良好,无并发症发生;B组院内猝死1例,余临床治愈出院,术后3个月随访8例,7例心脏超声提示心内畸形矫治良好,无并发症发生,院外猝死1例。两组患儿手术时间、体外循环时间、心脏停搏时间、自动复跳例数及术中血液超滤完成即时MAP等均差异无统计学意义。与A组比较,B组患儿术中血液超滤完成即时MPAP和CVP、监护室内血管活性药物评分、术后机械通气和监护室滞留时间、再次气管插管及肺部感染发生例数等均升高(均P<0.05);两组患儿术后MPAP均较术前明显下降(均P<0.05)。结论:6月龄以上患儿大动脉调转术术后并发症多,恢复慢且不平稳,有发生猝死的可能。
Objective: To observe the effect of aortic transfer in children over 6 months old. Methods: The children who underwent aortic revascularization in our center from June 2009 to July 2012 were divided into two groups according to hospitalization ages: group A (<6 months, 24 cases) and group B (≥6 months, 18 example). The surgical outcomes of the two groups were observed and the echocardiographic and complications were recorded at 3 months after discharge. The intraoperative conditions of the two groups were compared: operation time, cardiopulmonary bypass time, cardiac arrest time and heart auto-re-jumping after aortic opening; The circulatory function indexes were compared between the two groups: immediate average pulmonary arterial pressure (MPAP), mean arterial pressure (MAP), central venous pressure (CVP) and monitoring vasoactive drug score after operation, Pulmonary arterial pressure changes were compared between the two groups. The treatment of infants in the two groups were compared: mechanical ventilation time, treatment time in the care room, number of tracheal intubation (repeated) and number of pulmonary infections again. Results: A group of patients died on the day after surgery in 2 cases, more than the clinical cure and discharge, of which 12 cases were followed up 3 months after echocardiography showed good correction of intracardiac malformations, no complications; B group of hospital sudden death in 1 case, more than clinical cure , 8 cases were followed up for 3 months after operation. Seven cases of cardiac ultrasound showed good correction of intracardiac malformation, no complication and 1 case of sudden death from hospital. There was no significant difference in the operation time, cardiopulmonary bypass time, cardiac arrest time, the number of cases of spontaneous reperforation, and the instant MAP in the two groups. Compared with group A, blood transfiltration in patients in group B completed immediate MPAP and CVP, monitoring of vasoactive drugs in the laboratory, postoperative mechanical ventilation and stay in the care unit, re-tracheal intubation and the number of pulmonary infections (All P <0.05). The MPAP in both groups was significantly lower than that before operation (all P <0.05). CONCLUSIONS: Aortic transposition in children older than 6 months has more postoperative complications, slow and unstable recovery, and the possibility of sudden death.