非体外循环下有搏动性双向腔肺分流术的临床应用

Clinical Usefulness of Pulsatile Bidirectional Cavopulmonary Shunt without Cardiopulmonary Bypass

目的:总结非体外循环下施行有搏动性双向腔肺分流术的临床经验。方法:1995年9月～2006年8月,对22例复杂先天性心脏病患者在非体外循环下行双向腔肺分流术,术中不关闭主肺动脉。结果:全组无手术死亡,1例患儿因长时间机械通气导致肺部感染,2例术后出现上胸壁水肿,均经保守治疗痊愈;平均腔静脉阻断时间(23.8±1.1)min,胸腔引流液量(248.3±40.0)ml,机械通气时间(12.1±5.0)小时,住ICU时间(2.9±0.4)天,术后经皮血氧饱和度(0.89±0.01),较术前(0.65±0.02)明显升高(P<0.01)。平均术后随访(26.7±7.2)个月,早期两例失访,其余均恢复良好。结论:非体外循环下行有搏动性双向腔肺分流术安全可靠,适用于大多数不适合行双心室矫治的肺血减少型复杂先天性心脏病。

Objective：To review the experience of pulsatile bidirectional cavopulmonary shunt without cardiopulmonary bypass. Methods：Between Sept. 1995 and Aug. 2006,22 cases with complex congenital heart disease underwent bidirectional cavopulmonary shunt without cardiopulmonary bypass and the pulmonary artery was kept patent. Results：There was no operative mortality. One case was complicated with lung infection because of long period of ventilation and another two with chest edema. All of them were cured by expectant treatment. The mean crossclamp time for superior venous caval was （23.8 ± 1.1 ） min. The mean chest drainage was （ 248.3±40.0 ） ml. The mean ventilation time was （ 12.1±5.0） hours and the mean ICU stay was （ 2.9± 0.4 ） days. The postoperative oxygen saturation was （ 0.89 ± 0.01 ） , signifi- cantly higher than that of preoperatlon （ 0.65 ±0. 02,P 〈 0. 01 ）. The mean follow-up time was （ 26.7 ±7.2 ） months. The first two cases were lost of follow-up and the others recovered well. Conclusion：The pulsatile bidirectional cavopulmonary shunt without cardiopulmonary bypass is a safe and reliable method. It is recommended to the majority of the patients with inadequate pulmonary blood flow and complex congenital heart disease when double ventricle correction is not suitable.