婴幼儿法乐四联症的外科治疗

Primary Repair of Tetralogy of Fallot in Infancy

施行婴幼儿法乐四联症（ＴＯＦ）根治术１９１例。年龄０．５～３．０岁，１岁以下３０例。体重５．５～１４．２ｋｇ。手术死亡７例，病死率３．６６％。指出灌注肺是本组手术后死亡的主要因素（Ｐ＜０．０５），而左心室大小、肺动脉大小、合并畸形等并不是影响手术结果的主要原因。在死亡的７例中有３例灌注肺患儿，其原因可能与下列因素有关：体外循环放血，过度稀释，开放主动脉钳后发生灌注肺；复温时上下肢温差超过１０℃；体外循环不平稳流量时高时低。

From Sept. 1991 to Sept. 1994, 191 infants and children of tetralogy of Fallot (TOF) underwent primary repair at an average age of 2. 0±0. 83 years(0. 5～3. 0 years) , body weight 10. 19± 1. 80kg (5.5～14. 2kg).there were 30 cases within one year, 7 patients died (overall mortality 3.66%). Early primary repair of tetralogy of Fallot achieved a low mortality rate. Factors for the risky outcome were analysed, including: perfusion lung.size of left ventricle, diameter of left and right pulmonary artery, and other abnormalities. Through analysis, perfusion lung was the main reason of death in 3/7 cases.The following factors might be related to perfusion lung. 1,setting blood before CPB, overdilution of blood; 2, the temperature difference between the upper and lower body was greater than 10℃ in rewarming stage of CPB; 3, uneven perfusion flow-rate in CPB.