摘要
目的:评估婴幼儿期重症肺动脉狭窄(PS)外科手术的近期疗效,明确不同手术时机对PS疗效的影响。方法:回顾性分析2020年1月1日至2024年10月1日于中国人民解放军北部战区总医院行外科手术治疗重症PS的婴幼儿期患儿24例。男13例、女11例;患儿平均体质量(9.2±3.6)kg,平均孕周(39.3±1.7)周,平均月龄(15.0±13.5)个月,记录患儿术前主要症状体征(发绀、气促等)、跨肺动脉瓣压差(transpulmonary valve pressure gradient,TPVPG)、右心室收缩压(right ventricular systolic pressures,RVSP)、Em/Am等。按照不同的手术时机分为婴儿组(1岁以下)12例,和幼儿组(1~3岁)12例。结果:全部患儿无死亡,婴儿组术后ICU停留时间明显长于幼儿组,差异有统计学意义(P<0.05)。与术前对比,外科术后显著改善TPVPG,降低RVSP同时改善右心室舒张功能,右心室舒张功能改善至术后3个月基本稳定(P<0.05)。组间比较发现,婴儿组术后6个月TPVPG明显低于幼儿组;同时婴儿组术后右心室舒张功能明显改善,而幼儿组术后并未明显改善。月龄较小及右心室舒张功能下降是呼吸机辅助时间>24 h的主要危险因素。结论:PS患儿于婴幼儿期行外科手术安全有效,外科手术前的综合评估至关重要,早期行外科手术可有效改善右心室舒张功能。
Objective To evaluate the short-term efficacy of surgical treatment for severe pulmonary stenosis(PS)in infants and young children,and to clarify the impact of different surgical timings on the efficacy of PS treatment.MethodsA retrospective analysis was conducted on 24 infants and young children who underwent surgical treatment for severe PS at the General Hospital of Northern Theater Command,PLA,from January 1,2020,to October 1,2024.Among them,13 were males and 11 were females.The average weight of the patients was(9.2±3.6)kg,the average gestational age was(39.3±1.7)weeks,and the average age was(15.0±13.5)months.Preoperative clinical symptoms and signs(e.g.,cyanosis,shortness of breath),transpulmonary valve pressure gradient(TPVPG),right ventricular systolic pressure(RVSP),and Em/Am were recorded.The patients were divided into two groups based on surgical timing:the infant group(under 1 year old,n=12)and the toddler group(1-3 years old,n=12).ResultsThere were no deaths among all patients.The postoperative ICU stay was significantly longer in the infant group compared to the toddler group(P<0.05).Compared to preoperative values,surgical treatment significantly improved TPVPG,reduced RVSP,and enhanced right ventricular diastolic function,which stabilized by 3 months postoperatively(P<0.05).Intergroup comparisons revealed that the infant group had significantly lower TPVPG at 6 months postoperatively compared to the toddler group.Additionally,right ventricular diastolic function improved significantly in the infant group postoperatively,while no significant improvement was observed in the toddler group.Younger age and reduced right ventricular diastolic function were identified as major risk factors for prolonged mechanical ventilation(>24 hours).ConclusionSurgical treatment for PS during infancy and early childhood is safe and effective.Comprehensive preoperative evaluation is crucial,and early surgical intervention is recommended for patients with impaired right ventricular function to improve prognosis.
作者
张永
王鹏宇
王亮
谭逸明
辛芳冉
张旭
张春振
周子筠
吕丽华
方敏华
Zhang Yong;Wang Pengyu;Wang Liang;Tan Yiming;Xin Fangran;Zhang Xu;Zhang Chunzhen;Zhou Zijun;Lyv Lihua;Fang Minhua(Department of Cardiovascular Surgery,Northern Theater General Hospital,Shenyang 100016,China)
出处
《中华胸心血管外科杂志》
2025年第10期584-588,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
辽宁省自然科学基金医工交叉项目(2022-YGJC-12)。
关键词
重症肺动脉狭窄
婴幼儿期外科手术
近期疗效
右心室舒张功能
Severe pulmonary stenosis
Infant and early childhood surgical intervention
Short-term therapeutic efficacy
Right ventricular diastolic function
