15岁以上法乐四联症外科纠治术91例

SURGICAL CORRECTIVE TETRALOGY OF FALLOT OVER 15 YEAR OLD PATENTS IN 91 CASES

本文总结１９８４年７月至１９９４年６月１５岁以上法乐四联症外科纠治９１例的经验体会。手术采用经胸骨正中切口，全稀释预充液体外循环下进行，全身肝素用量为２ｍｇ／ｋｇ，鼻咽温度至２３～２５℃。手术尽量保留心室心肌，保护右室收缩功能，放宽采用右室流出道及跨瓣环扩大补片成形指征。结果：术毕心内测压，右室／左室收缩压比＜０．７５者７３例，术后恢复顺利，而余１８例＞０．７５，术后均有低心排。术后呼吸功能衰竭者４例，进胸止血５例，完全房室传导阻带者１例，死亡７例，死亡率７．７％。本文结果提示：１５岁以上法乐四联症根治术成败的关键在于术中避免右室心肌不必要的医源性损伤，放宽采用右室流出道扩大补片的指征；术后及时纠治低心排，加强呼吸道护理，防止低氧血症等。

his article reported the experience on surgical corrective Tetralogy of Fallot(TOF)over 15 year old patients in 91 cases from 1984,7 to 1994,6.All patients were undergoneright ventricular catheterization,the LVEDVI was all over 30ml/m￣2 except one case,The in-cision was done in the middle of sternum,Cardiopulmonary bypass was begun under wholeblood dilution, heparinization(2mg/ kg)and low temperature(nasopharyngeal 23～25℃).The systolic pressure ratio of right/left ventricle was less than 0. 75 in 73 cases but morethan 0.75 in 18 cases who suffered the low cardiac output.Seven cases died,the mortalitywas 7.7%in this group. The key points of surgical correction of TOF lay in less ventricularmuscle cut off and more patches usage to enlarge the right ventricular outflow tract and en-sure the systolic pressure ratio of right/left ventricle less than 0. 75 after operation.