小儿双向腔肺吻合术的早期疗效

Early effect of bidirectional glenn procedure in pediatric patients

目的探讨影响小儿双向腔肺吻合术(BDG)疗效的因素及降低死亡率的措施。方法收集2000年3月至2004年3月实行BDG手术患儿119例,男性68例,女性51例;平均年龄(39.34±42.31)月;平均体重(12.52±7.15)kg。所有病例持续监测经皮氧饱和度(TcO2)和颈内静脉压(CVP),随访超声心动图(ECHO)。结果全组病例术后TcO2较术前上升17.2%(t=-15.19,P=0.038)。肺动脉开放病例术后TcO2显著高于肺动脉结扎或离断病例(F=7.94,P=0.006);<4岁的患儿术后TcO2显著高于≥4岁的患儿(F=6.22,P=0.014);非体外循环病例术后TcO2显著高于体外循环病例(F=5.98,P=0.016)。术后47例(39.5%)患儿CVP增高,9例患儿CVP恢复异常;低氧血症10例(8.4%);随访超声心动图患儿中11例(9.2%)存在解剖问题,再次气管插管和手术各6例。死亡7例(死亡率5.9%)。结论BDG术后同时出现CVP恢复异常、低氧血症的病例往往是导致手术不良预后的重要因素,及时进行ECHO和心导管造影,尽早采取干预措施可降低死亡率。

Objective To evaluate the early effect of bidirectional glenn procedure in pediatric patients. Methods One hundred and nineteen pediatric patients （Male 68, Female 51） subjected to bidirectional Glenn procedure from March 2000 to March 2004 were enrolled for this study, with mean age （39.34±42.31）month and mean weight （12.52±7.15）kg. Continuous transcutaneous oxygen saturation （TcO2） and superior vena cava pressure （CVP） were measured after surgery. After operation, echo examination was followed up. Results Bidirectional Glenn procedure enhanced TcO2 by 17.2%（P=0.038）, with higher TcO2 in pulmonary artery open cases than in pulmonary artery closed cases （P=0.006）. Patients under age of 4 had higher TcO2 level than those over 4 years old（P=0.014）. TcO2 in patients with off-pump Gleen was higher than those with cardiac bypass（P=0.016）. The operation resulted in an increase of CVP in 47 cases （39.5%）. CVP reversed to abnormity in 9 cases. Ten of them （8.4%） had hypoxemia. Among all patients in the study, 11 cases （9.2%） had residual anatomy problems, 6 cases with re-intubation, 6 cases with re-operation, and 7 cases （5.9%） died after operation. Conclusion Delayed recovery of CVP combined with hypoxemia was an important indicator of bad prognosis after BDG. Early echo and catheterization examination was useful to find problems out and take intervention as soon as possible, which will be helpful to decrease mobility postoperatively.