非体外循环下复杂先天性心脏病的姑息手术

Palliative procedures for complex congenital heart diseases without cardiopulmonary bypass

目的:探讨非体外循环下复杂先天性心脏病姑息手术适应证及处理要点。方法:2008-01-2010-06对26例复杂先天性心脏心病患儿实行非体外循环下姑息手术,其中肺动脉环缩术5例,改良体肺分流术6例,双向腔肺分流术14例,双向腔肺分流+改良体肺分流术1例;其中功能单心室9例,法洛四联症肺动脉闭锁6例,右室双出口4例,三尖瓣闭锁3例,完全性大动脉转位2例完全心内膜垫缺损并肺动脉闭锁1例,Ebstein畸形1例。结果:死亡4例,22例患者顺利出院,死亡率15.4%;死亡原因包括低氧血症及心功能衰竭、肺部感染合并心功能衰竭;肺动脉环缩术、改良体肺分流术、双向腔肺分流术后平均血氧饱和度分别为(81.8±2.4)%、(90.0±3.2)%、(86.4±4.1)%;术后并发症包括肺部感染3例,胸腔积液7例,上腔静脉综合征1例。术后随访2个月～1年,无远期死亡,心功能NYHAⅠ级7例,NYHAⅡ级15例。结论:非体外循环下姑息治疗是复杂先天性心脏病的有效治疗手段,特别适用于有体外循环高危因素患者,手术适应证的正确把握、术中术后合理的处理是降低死亡率的关键。

Objective：To summarize the experience and results of palliative treatment for patients with complex congenital heart disease（CCHD）.Method：From May 2008to June 2010,26patients with complex congenital heart diseases with age ranging from 2months to 4years（mean age[9.4±5.5]month）underwent palliative treatment.The body weight ranged from 5to 19kg（mean weight[8.6±4.2]kg）.5patients underwent Pulmonary Artery Banding（PAB）procedure;Modified Blalock-Taussig Shunt（MBTS）in 6;and Bidirectional Cavopulmonary Shunt（BDCPS）in 15.All procedures were performed through a Median sternotomy without cardiopulmonary bypass（CPB）.Result：There were 4early deaths（15.4%）,21 patients were discharged without serious complication.The death reasons include hypoxia,heart failure,and pulmonary infection.SaO 2 was（90.0±3.2）%after PAB,（86.4±4.1）%after MBTS and（86.4±4.1）%after BDCPS.22patients were followed up from 2 months to 1 year.The cardiac functions were NYHA classⅠin 7 and classⅡin 15.The outcome was satisfactory.Conclusion：Palliative procedures without CPB are effective in relieve symptom and providing agood survival for patients with CCHD by avoiding systemic inflammatory and ischemic damage of CPB.Operational indication in selected patients and appropriate peri-operation treatment are important for improving the outcomes.