复杂大动脉调转术后恢复特点及治疗对策

Postoperative Management of Arterial Switch Operation for Complex Transposition of the Great Arteries

目的总结复杂大动脉调转手术(ASO)后早期恢复特点及治疗对策。方法对129例患儿实施ASO,包括:合并室间隔缺损大动脉转位(TGA)83例;Taussig-Bing畸形34例;矫正型TGA(ccTGA)12例。年龄6 d^7岁(17.25±22.66)月;体重3~25(9.42±5.50)kg。术前72例(55.38%)合并中至重度肺动脉高压。所有患儿均在全麻、低温、体外循环下完成ASO手术,10例合并肺动脉瓣狭窄者行Nikaidoh手术。12例ccTGA先行心房转流术(Senning),然后行ASO手术。14例(10.77%)合并有冠状动脉畸形,包括壁内走行3例。术后给予呼吸、循环综合管理,对合并肺动脉高压者配合吸入一氧化氮(NO),常规治疗无效的心肺功能不全应用体外膜肺氧合(ECMO)辅助。结果院内死亡10例,死亡率7.75%,死亡原因分别为冠状动脉壁内走行,反复吻合仍停机困难2例;早期严重低心排3例;心跳骤停1例;术后乳糜胸试用稀释碘伏闭合乳糜管发生严重过敏反应1例;感染继发多器官衰竭3例。余119例均平稳出院。结论对部分年龄偏大,合并肺动脉高压的复杂TGA患儿行ASO手术,早期处理得当,仍可取得满意的临床效果。

OBJECTIVE To sum up the postoperative management of arterial switch operation （ASO） for complex transposition of the great arteries （TGA - VSD）. METHODS 129 patients with complex transpesition of the great arteries received ASO from Jan. 2001 to Mar. 2007. There were 83 patients with TGA -VSD, 34 patients with Taussig - Bing anomaly and 12 patients with congenitally corrected TGA （ccTGA）. Age at operation ranged from 6 days to 7 years （17.25 ±22.66 months） , and the mean body weight was （9.42±5.50）kg. In these patients 72 cases had middle -severe pulmonary hypertension. All the patients were performed by ASO while 10 cases with pulmonary valves stenosis were performed by Nikaidoh procedure and 12 cases of ccTGA by double switch operation including Senning procedure and ASO. There were 14 cases with single ostium patterns and 3 cases with intramural coronary arteries. The postoperative management including the respiratory and circulatory support as well as the treatment of pulmonary hypertension. RESULTS The hospital mortality rate was 7.75% （ n = 10 cases） in 129 patients. CONCLUSION ASO can be performed safely and has satisfactory results in TGA and Taussig - Bing anomaly or ccTGA. Correct management for these patients in the early days after operation could efficiently prevent the postoperative pulmonary hypertension crisis.