肺动脉环缩术治疗不同年龄伴肺动脉高压单心室

Contrast research in the application of pulmonary artery banding in the single ventricle repair pathway in different age patients with pulmonary artery hypertension

目的总结肺动脉环缩术（PAB）在不同年龄段伴肺动脉高压先天性心脏病患儿行单心室修复术中的应用效果。方法49例合并重度肺动脉高压仅能行单心室修复的复杂畸形患儿，男31例，女18例；年龄0．2～10岁，平均（7．8±3．8）岁；体重5—24kg，平均（8．82±4．24）kg；经皮血氧饱和度（SPO，）0．85～1．00，平均（0．90±0．04）；术前肺动脉平均压（mPAP）52—91mmHg（1mmHg=0．133kPa），平均（54．6±16．8）mmHg。合并单心室13例，三尖瓣闭锁12例，室间隔缺损远离两大动脉伴左心室发育不良型右室双出口11例，三尖瓣重度狭窄5例，心室不均衡型完全型房室通道5例，十字交叉心3例。根据年龄分为3组：≤0．5岁17例、0．5～2．0岁17例、≥2．0岁15例。全组均先期行PAB，静脉吸入复合麻醉，吸入氧浓度40％时，SPO2 0．85，肺动脉平均压20mmHg。对比分析3组术后SPO2、mPAP、呼吸机使用时间、ICU停留时间以及手术死亡比率。结果手术死亡1例系1岁6个月患儿，死因为肺部感染。全组术后肺动脉压明显下降。3组术后SPO2、mPAP、呼吸机使用时间、ICU停留时间均无明显区别。随访6—72个月，1例1岁2个月患儿术后2个月因误吸死亡；3例已完成双向格林或全腔肺动脉吻合术。结论PAB能有效降低不同年龄段伴肺动脉高压拟行单心室修复的先心病患儿的肺动脉压力，术后效果良好。

Objective Contrast research the operative effect of the pulmonary artery banding （PAB） in the congenital heart disease with pulmonary artery hypertension, underwent the single ventricle repair procedure in different age. Methods 49 cases, male 31 and female 18. Age （7.8 ±3.8） years old, weight （8.82 ±4.24） kg, percutaneous blood oxygen saturation （ SPO2 ） 0.90 ± 0.04, preoperative mean pulmonary artery pressure （mPAP） （54.6 ± 16.8 ） mm Hg. single ventricle 13 cases, tricuspid atresia 12 cases, double outlet of right ventricle with left ventricular dysplasia 11 cases, tricuspid stenosis 5 cases, ventricular imbalance type complete atrioventricular canal defect 5 cases and cross heart cases 3 cases, divided into three groups： ≤0.5 years old of 17 cases, 0.5 to 2.0 years old of 17 cases, ≥2.0 years old 15 cases. All cases taken PAB under anesthesia and cpb, inhaled oxygen concentration 40%, SPO2 0.85, MPAP 20 mmHg. comparatively analysis postoperative SPO2 , MPAP, Ventilator using time, ICU stay time and operation mortality of the three groups. Results The postoperative PAP obviously decreased. Three groups of postoperative SPO2 , mPAP, ventilator using time, ICU stay time were not significandy different. More than were followed up 6-72 months, 1 cases （1-2 months） dead in aspiration two months postoperation. the other three cases had been completed Glenn and/or Fontan. Conclusion PAB can effectively reduce the pulmonary artery pressure in the different age children with congenital heart disease and pulmonary Artery hypertension, the effect is good. more than 2 years old children still PAB feasible operation, and likely to complete the Glenn and/or Fontan procedure.