非体外循环与体外循环心外管道全腔静脉-肺动脉连接术的对比研究

Comparative research of extracardiac conduit total cavopulmonary conn ection with and without the use of cardiopulmonary bypass

目的 比较常温非体外循环 (OPCPB)和低温体外循环 (CPB)下心外管道全腔静脉 -肺动脉连接术(TCPC)治疗功能性单心室复杂畸形的效果。 方法 根据术中是否采用 CPB,将 2 8例功能性单心室复杂心脏畸形患者分为两组 ,OPCPB组 :11例 ,均在 OPCPB下行心外管道 TCPC;CPB组 :17例 ,均在 CPB下行心外管道TCPC。记录两组患者中心静脉压 (CVP)、平均体动脉压、胸腔引流液量、机械辅助通气时间、术后住院时间、血液制品用量、住院费用和出院时脉搏血氧饱和度 (Sp O2 ) ,并进行比较。 结果 两组术后早期死亡率无明显差别 ,术后OPCPB组 CVP明显低于 CPB组 (P<0 .0 5 ) ,胸腔引流液量、机械辅助通气时间、住 ICU时间和术后住院时间较CPB组明显减少或缩短 (P<0 .0 5 ) ,血浆用量明显减少 (P<0 .0 5 ) ,住院费用明显低于 CPB组 (P<0 .0 5 ) ,两组 Sp O2差别无显著性意义 (P>0 .0 5 )。 结论 在 OPCPB下行心外管道 TCPC并非十分困难 ,术后血流动力学明显优于CPB下行心外管道 TCPC,围术期血液制品用量减少 ,有利于早期恢复 ;术后住院时间短 。

Objective To compare the surgical methods and resu l ts of the extracardiac conduit total cavopulmonary connection (TCPC) with off-p ump (OPCPB) and cardiopulmonary bypass (CPB). Methods Acc ording to whether the CPB was used or not during operation, 28 patie nts with functional si ngle ventricle were divided into two groups. OPCPB group: 11 patients under went the extracardiac conduit TCPC with OPCPB. CPB group: 17 patients under w ent the extracardiac conduit TCPC with CPB. The central venous pressure ( CVP), mean blood pressure, the thoracic drainage, time of mechanic ventilation, the time of stay in hospital, the used volume of blood and blood products, the c ost in hospital, percutaneous oxygen saturation (SpO 2) were record fo r all patients, and the results in two groups was compared. Results There was no significant difference in operative mortality for both group s. The early postoperative CVP was lower in OPC PB group than that in CPB group(P<0.05), the thoracic drainage, the intubat ion t ime, the stay in intensive care unite and hespital after operation were less or shorter in OPCPB group(P<0.05), transfusion of blood plasma was significant ly less (P<0.05); the expense was significantly less in OPCPB group (P<0 .05). There was no significant difference in SpO 2 at discharge for bo t h groups. Conclusions Extracardiac conduit TCPC with OPCPB is not difficult to manage, the procedure results in improved immediate postoperative hemodynamic , and decreased use of blood and blood products; it is a more-efficient operati on with a more rapid recovery time and hospital stay.