大动脉调转术后的早期处理

Early management after switch procedure

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 review the experiences of perioperative management after switch procedure.Method:Five patients received Switch operation. The operation was carried out under deephypothermia circulator arrest and low-flow perfusion. Colloid was infused immediately after operation. Proper respiratory alkalosis was maintained. Inotropic support and drug decreasing pulmonary resistance were used.Result:There was no operative death. The leading complications were low cardiac output syndrome, atrial tachycardia, lung infections and hypoxemia.Conclusion:To improve the operative results, enough preload should be maintained, low pulmonary resistance as well as low left atrial pressure should be maintained postoperatively. Low cardiac output syndrome, tachycardia and hypoxemia should be treated in time. Early therapy may effectively assure the successes of the operations.