快速二期大动脉转位术的左心室功能判断

Judgement of the left ventricle retraining in the rapid two stage-switch operation

目的 总结完全性大动脉转位行快速二期大动脉转位术的左心室功能锻炼结果,探讨判断左心功能锻炼效果的指标和二期大动脉转位术的最佳手术时机.方法 2002年9月至2007年9月21例患者接受快速二期大动脉转位术.其中男性13例,女性8例;手术年龄29～250 d,中位数75 d,平均（103±69）d;体质量3.5～7.0 kg,中位数5.0 kg,平均（5.0±1.2）kg.所有患者先行一期左心功能锻炼术,术后常规隔天复查床旁超声心动图.测量左心室舒张末期内径、左心室后壁舒张期厚度和舒张期室间隔厚度,根据公式计算左心室质量和左心室质量指数.结果 两次手术平均间隔（9±5）d.一期术后,左右心室压力比从术前的0.47±0.15上升至0.91±0.20（P＜0.01）.左心室质量指数从（30±11）g/m2上升至（63±20）g/m2（P＜0.01）.一期术前与二期大动脉转位术前的左心室舒张末期内径、左心室舒张末期容积、左心室后壁舒张期厚度以及舒张期室间隔厚度,差异有统计学意义（P＜0.05）.结论 左心功能退化的完全性大动脉转位患者,经左心室锻炼术后左心功能可得到锻炼恢复.左心功能锻炼期的时间为7～10 d.左右心室压力比大于0.65,左心室质量指数50g/m2是判断左心功能锻炼结果的主要指标.

Objectives To Summarize the results of left ventricle retraining in rapid two-stage switch operation and to determine the estimating index of left ventricle retraining and the best time of the second stage operation. Methods From September 2002 to September 2007, 21 patients underwent rapid two stage switch operation. There were 13 male and 8 female patients, ageing from 29 to 250 d [mean （ 103±69） d, median 75 d], weighting from 3.5 to 7.0kg [mean （5.0 ＋ 1. 2） kg, median 5.0 kg]. After pulmonary band, bedside echocardiography was regularly done every other day. Paired t-test was used to analyze the changes of left ventricular end-diastolic dimension （ LVDd ）, left ventricular posterior wall dimensions （ LVPWd）, diastolic intra-ventricular septal dimensions （ IVSd）, left ventricular （LV） mass and LV mass indexed for body surface area. Results The mean interval was （ 9 ＋ 5 ） d. After the left ventricle preparative operation, the left ventricular to right ventricular pressure ratio （pLV/RV） raised from 0.47 ＋0. 15 to 0.91 ±0.20 （P＜0.01）. LV mass indexed for body surface area raised from （30＋11） g/m2 to （60±20） g/m2（P＜0.01）. Extremely significant difference of LV mass existed between pre-arterial switch operation and pre-left ventride preparative operation, and significant difference existed in LVDd,LVDd3, LVPWd and IVSd between the two operative timing points. Conclusions The left ventricular function of the transposition of the great arteries can be retraining by the left ventride preparative operation. The interval of left ventricle retraining should be controlled in 7 to 10 d, and the pLV/RV reach 0. 65 and the LV mass index over 50 g/m2 are two important indicators of the second stage operation of arterial switch operation.