法洛四联症术后早期并发症的临床研究

The observation and treatment for early postoperative complication of TOF

目的总结法洛四联症(TOF)根治术后早期并发症的治疗经验。方法连续手术治疗156例TOF患者。其中男性83例,女性69例;左室舒张末期容积指数(LVEDI)19～37(30.4±2.6)ml/m2;McGoon比值1.1～2.1(1.5±0.4)。9例在非体外循环下行中央分流术,147例在低温体外循环下行TOF根治术(其中4例为中央分流术后Ⅱ期根治术),同时进行双向格林手术、右室至肺动脉人工血管外通道(Rastelli)术及主动脉瓣替换术各1例。均用涤纶片修补室缺,未加宽流出道5例,其余用自体心包片加宽流出道,其中跨环128例、非跨环14例。结果术后早期(30d内)死亡4例,手术死亡率2.56%。死亡原因为低心排综合征、心功能衰竭3例,灌注肺、呼吸衰竭1例。出现并发症27例,主要有低心排、低氧血症、心包填塞、出血、肾功能衰竭、残余漏、乳糜胸等。随访1～36个月,晚期死亡1例,死于大量心包积液所致的心律紊乱。结论术中手术畸形矫治满意度,术后高质量的ICU诊疗与护理可以减少和避免一部分并发症的发生。

Objective To conclude experience of treatment for early postoperative complication of TOF. Methods 156 cases of consecutive TOF operative patients, there are 83 cases in male and 69 cases in female, LVEDI： 19-37 （30.4±2.6）ml/m^2, McGoon 1.1-2.1 （ 1.5 ±0.4）. 147 have been performed total correction surgical procedure, among them one-stage 143 cases, two-stage 4 cases. The other 9 cases underwent off pump shunt operation. Results 4 cases died in early stage after operation （〈30 d）,and the hospital mortality was 2.56%.Three of them died from severe low cardiac output syndrome, and one died from perfusion lung and respiratory failure. Follow up 1-36 months, 1 case died from arrhythmia caused by chronic pericardiae tendon in late stage.27 cases have postoperative complication, they are LCO syndrome, hypoxemia, cardiac tamponade, dysrythmia, hemorrhage, renal failure, residual fistula, chymal chest ect. Conclusion Part of postoperative complication can be reduced and prevented by complete correction of the anomaly during operation and by high quality diagnosis,treatment and nursing care in the ICU.