摘要
目的:本文通过360例3个月至5岁小儿法乐四联症的根治术,介绍如何降低手术死亡率的经验。方法:1993年1月至1995年9月,为360例(男265例,女95例)3个月至5岁的患儿行法乐四联症根治术,平均年龄2.76±1.49岁,平均体重11.45±3.25(5~19)kg。全麻、深低温(鼻温20℃)、低流量(20~40ml·kg-1/min)体外循环下行根治术,包括修补心室间隔缺损,右心室流出道加宽。138例(38.33%)跨环补片,107例至左右肺动脉分叉处或左肺动脉起始部,26例用液氮保存的同种带瓣升主动脉(19例取自新生儿,7例取自成人),手术同期纠正其他心内畸形187例(51.94%)。结果:手术死亡4例(1.11%),死因为灌注肺2例,心包填塞及呼吸衰竭各1例。结论:尽管手术适应证较宽,但手术死亡率近年明显下降,这主要与术前纠正贫血、畸形纠正满意、心肺保护良好和正确的术后处理有关。
Objective:This study was conducted to describe the experience of decreasing the operative mortality of total correction of tetralogy of Fallot in pediatric patients. Methods:From Jan.1993 to Sept.1995,360 pediatric patients(265 boys and 95 girls),aged 3 months to 5 yrs(mean 2 76±1 49 yrs)with body weights of 5 to 19 kg(mean 11 45±3 25 kg),underwent total correction of tetralogy of Fallot at Fu Wai Hospital.All of the cases were totally corrected under deep hypothermia(20℃)with low flow CPB(20 40 ml·kg -1 /min).The procedures included VSD repair with dacron patch,valvotomy for pulmonary valve stenosis,resection of the hypertrophic right infundibulum and enlargement of the RVOT and pulmonary trunk.In the 138 cases with transannular patching,aortic homograft patch with valve was used in 26(19 were obtained from neonates and 7 from adults),and autogenous pericardial patch in the others.Transannular patching to pulmonary bifurcation or to left pulmonary artery was performed on 107 cases.Associated anomalies found during operation in 187 cases(51 94%)were corrected. Results:There were 4 postoperative deaths(1 11%)from ARDS(2 cases),tamponade(1 case)and respiratory failure(1 case). Conclusion:Although the indications for total correction of tetralogy of Fallot had been extened recently at our hospital,the operative mortality decreased obviously ,it is related to satisfactory correction of the anomalies,good perioperative protection of the heart and lung function,prompt and correct postoperative management.
出处
《中国循环杂志》
CSCD
1996年第8期453-456,共4页
Chinese Circulation Journal
关键词
法乐氏四联症
根治术
儿童
先天性心脏病
Tetralogy of Fallot
Total correction
Children (Chinese Circulation Journal,1996,11:453.)