肺血减少型复杂先天性心脏病233例围手术期的处理

Perioperative management of 233 cases of congenital heart diseases with diminutive pulmonary blood

目的:总结肺血减少型复杂先天性心脏病(先心病)的围手术期处理经验。方法:对233例手术治疗的肺血减少型先心病患儿的围手术期处理进行回顾性分析。术前心脏超声心动图、磁共振或螺旋CT心血管成像等检查明确诊断并对肺血管发育进行全面客观评估后,制定适当手术方案。行各类解剖矫治术201例,各类生理矫治及姑息性手术32例。术后密切观察各监护指标变化,并给予充分镇静、适当体位、循环及呼吸功能支持。结果:体外循环(118.23±27.25)min,主动脉阻断73.26min,术后呼吸机辅助(17.64±12.23)min,术后多巴胺平均用量(7.52±2.12)mg.kg-1.min-1,术后监护(73.2±24.5)h,术后住院(9.5±5.6)d。手术死亡11例,病死率4.7%;各类手术并发症52例,发生率23.4%,近、远期随访结果无死亡病例。结论:客观全面的术前影像学评估,正确的手术方式的选择及术后监护和治疗可大大提高手术疗效,降低手术并发症发生率及手术病死率。

Objective：To sum perioperative management experiences of congenital heart diseases with diminutive pulmonary blood. Methods：The data of 233 cases with congenital heart diseases with diminutive pulmonary blood were analyzed retrospectively. The appropriate surgical programme was formulated after the diagnosis was confirmed by cardiac echocardiography, magnetic resonance imaging or spiral CT and pulmonary vessels were evaluated. Two hundred and one cases were treated with anatomical correction surgery and 34 cases were treated with physical or palliative surgery. All monitoring index of all cases were observed, and which were given full sedation, proper posture, circulation and respiratory support after opertaion. Results： The cardiopulmonary bypass time was （ 118.23±27.25 ） minutes, aortic cross-clamping time 73. 26 minutes, postoperative ventilation time （ 17. 64± 12. 23 ） minutes, average application amount of dopamine （ 7.52± 2.12 ） mg · kg^ - 1 . min·^-1, intensive care time for （ 73.2±24.5 ） hours and postoperative hospital stay time （ 9. 5 ±5. 6 ） days. Eleven patients died （ mortality as 73. 3% ） during intraoperative. Fifty-two patients had complications（ incidence rate as 23.4% ） and no one died. Conclusions：The objective and comprehensive assessment of preoperative imaging, the correct choice of operation and postoperative care and treatment can greatly improve the surgical effects, reduce the incidence of surgical complications and mortality.