143例法洛四联症手术后早期处理

Early management after correction of tetralogy of Fallot: review of 143 cases

目的总结法洛四联症(TOF)根治手术后近期处理特点。方法143例TOF根治术患者,术后适当延长呼吸支持时间,加用呼气末正压通气(PEEP),及时补充胶体溶液,应用正性肌力药物及降低肺血管阻力药物。同时注意尿量的维持,以减轻血红蛋白尿对肾脏造成的损害。结果术后合并低心输出量综合征24例(16.8%),室上性心动过速53例(37.1%),Ⅱ～Ⅲ度房室传导阻滞8例(5.5%),低氧血症83例(58.0%),二次手术止血8例(5.6%)。早期死亡3例,病死率2.1%。结论TOF术后维持足够前负荷,积极采取有效措施降低肺循环阻力,及时纠治低心输出量综合征、心律失常、低氧血症、肾功能衰竭等并发症,可有效提高手术成功率。

Objective To review the experiences of postoperative management of tetralogy of Fallo.?Menthods 143 patients with tetralogy of Fallot (aged 2～34, body weight 8～42 kg) were operated on. Proper respiratory support and PEEP were used immediately after operation. Colloid infusion,inotropic support and drugs decreasing pulmonary resistance were administered.?Results Low cardiac output syndrome developed postoperatively in 16.8% patients, atrial tachycardia in 37.1%, Ⅱ～Ⅲ degree atrioventricular block in 5.5%, and hypoxemia in 58.0%. Second operation was performed in 5.6% patients.There were 3 operative deaths, with a hospital mortality of 2.1%.?Conclusion Enough preload and low pulmonary resistance should be maintained postoperatively. Low cardiac output syndrome, tachycardia and hypoxemia should be treated in time. Early prevention of acute renal failure may effectively assure the successes of the surgery.