体外循环下处理动脉导管未闭手术32例分析

ANALYSIS OF THE MANAGEMENT OF 32 PATENT DUCTUS ARTERIOSUS THROUGH CARDIOPULMONARY BYPASS

目的探讨体外循环下(CPB)处理动脉导管未闭(PDA)的外科治疗经验。方法回顾性分析本院1994年10月～2011年10月在体外循环下处理32例PDA的临床特点、手术方式及转归。结果术后1例患者出现灌注肺,1例患者重度肺动脉高压导致右心功能不全,1例出现肺动脉高压危象,其余患者均康复出院,复查动脉导管无再通。结论合并心内畸形的PDA,术前诊断及术中探查是关键,心内直视手术前处理好PDA,可减少术后并发症。对单纯PDA应严格掌握体外循环下手术的适应症。绝大多数PDA均可进行心包内游离,充分显露是手术的关键。结合心包内分离及经肺动脉切口处理PDA,可明显缩短CPB时间,减少术后并发症,缩短术后康复时间。

Objective To investigate the experience in cardiopulmonary bypass（CPB） surgical treatment of patent ductus arteriosus（PDA）. Methods Retrospectively analyze the experience in cardiopulmonary bypass treatment in 32 cases of PDA about clinical features,operation modes and prognosis in our hospital from 1994 October to 2011 October. Results One patient appeared perfusion lung,one patient with severe pulmonary hypertension led to right heart dysfunction,one with pulmonary hypertension crisis,the remaining patients were discharged,reviewed no recanalization catheter. Conclusion In PDA with cardiac anomalies,preoperative diagnosis and intraoperative exploration is the key,dealing with PDA before open-heart operation can reduce the postoperative complications.On the simple PDA,we should master the indications of operation under cardiopulmonary bypass.The vast majority of PDA can be carried out within the pericardium,fully reveal is the operation key.Combination of intrapericardial separation and pulmonary artery incision in processing PDA,can significantly shorten the time of CPB,reduce postoperative complications and shorten postoperative recovery time.