摘要
目的总结Gore—Tax心外管道治疗先天性心脏病单心室的临床体会，探讨心外管道开窗术的治疗效果。方法1996年6月至2010年7月我们对95例先天性心脏病单心室患儿行心外管道纠治术治疗，71例行心外管道开窗术（开窗组），其中58例（58／71）术前高风险患儿术中行开窗术，13例（13／71）患儿因术后低心排行介入开窗术；24例（24／95）术中未行心外管道开窗术（非开窗组）。结果开窗组无死亡；非开窗组死亡3例。开窗组术后胸腔引流时间平均（10．0±3．2）d，非开窗组平均（14．2±2．3）d，差异有统计学意义（P=0．016）；开窗组术后平均肺动脉压（13．2±2．8）mmHg，非开窗组（15．1±3．4）mmHg，差异有统计学意义（P=0．017）；开窗组及非开窗组术后血氧饱和度[（90．3±4．0）％、（91．7±5．2）％]、术后血栓[11．3％（8／71）、12．5％（3／24）]及心律失常发生率[18．3％（13／71）、20．8％（5／24）]相比差异均无统计学意义（P均〉0．05）。结论Gore—Tax心外管道术式治疗先天性心脏病单心室安全、有效；心外管道通过开窗术增加左心室的心输出量，从而降低术后早期病死率。
Objective To sum the clinical experiences of the treatment in congenital heart disease single ventricle with extraeardiae conduit （EC） fenestration. Methods Ninety-five patients diagnosed with univentrieular heart disease underwent EC using Gore-Tax conduits at the Department of Children＇s Heart Center ,Justus-Liebig-University Giessen Germany from June 1996 to July 2010. According to EC with or without fenestration, the patients were divided into two groups. Seventy-one routine fenestration of the extracardiac conduit （the fenestration group）, 58 patients （58/71） of children with high-risk preoperative intraoperative fenestration, 13 cases （13/71） were due to low cardiac Rankinginterventional fenestration; extracardiae conduit fenestration （non-windowed group） did not undergo surgery in 24 patients （24/95）. Results The fenestration had no death; Three died in non-windowed group. Postoperative effusions and postoperative mean pulmonary artery pressure in group without fenestration （ （ 14. 2 ± 2. 3 ） d and （ 15.1 ± 3.4 ） mm Hg respectively ） were significantly higher than group with fenestration （ （10 ±3.2） d and （13.2 ±2. 8） mm Hg respectively）. It had significant differences （P = 0. 016）. In the group with fenestration and without fenestration, postoperative oxygen saturation （ （90. 3 ± 4.0 ） %, （ 91.7 ± 5.2 ） % ）, postoperative thrombosis （ 11.3 % （ 8/71 ）, 12.5 % （ 3/24 ） ）, and postoperative neurological problems （18.3% （13/71）, 20.8% （5/24）） did not differ between cohorts. Conclusion It is effective and safe to treat congenital heart disease single ventricle with EC. EC with fenestration can improve acute postoperative mortality by rising cardiac output, thereby can reduce early postoperative mortality.
出处
《中国综合临床》
2013年第4期405-408,共4页
Clinical Medicine of China
关键词
先天性心脏病
心外管道
单心室
开窗术
Congenital heart disease
Extracardiac conduit
Univentricular heart
fenestration
