主动脉弓病变43例术后早期结果分析

Analysis of early results of 43 children with aortic arch lesion after operation

目的探讨主动脉弓病变手术术后早期临床结果，以提高手术成功率、降低病死率和缩短ICU治疗时间。方法回顾性分析2012年1月至9月在阜外心血管病医院连续完成的43例主动脉弓病变手术患儿术后早期临床资料。男26例，女17例；年龄29d～10岁，中位年龄6个月；体质量3．2～38．0kg，中位体质量6．0kg。9例为单纯主动脉弓病变或仅合并单一心内畸形，34例为合并2种或2种以上复杂心内畸形。分别按年龄及ICU滞留时间进行分组研究。结果术后呼吸机辅助中位数时问为23h，ICU治疗中位数时间为3d；死亡3例。≤6个月小婴儿术后呼吸机辅助和ICU治疗时间明显长于〉6个月婴幼儿。单因素分析结果认为年龄小，体质量低，合并复杂畸形，阻断时间、转机时间及呼吸机辅助时间长是术后患儿滞留ICU的危险因素。15例患儿发生术后并发症，其中肺部感染12例，渗漏综合征5例，气管狭窄2例，低心排综合征2例。低心排综合征经体外膜肺氧合辅助和心肺复苏术抢救成功。结论主动脉弓病变手术效果确切，术后病情复杂。年龄≤6个月的危重主动脉弓病变合并复杂心内畸形的患儿亟待手术，但手术有风险，术后ICU滞留及并发症发生率高。相对而言，年龄〉6个月的主动脉弓病变患儿手术及术后更加安全。

Objective To analyze the clinical data of aortic arch lesions after operation in order to provide better operation and decrease the mortality and shorten the duration of intensive care unit （ICU） treatment. Methods Forty-three children with aortic arch lesions including 26 male and 17 female in Fuwai Angiocardiopathy Hospital between Jan. and Sep. 2012 were enrolled. The ages ranged from 29 days to 10 years old with the median age of 6 months and the weight ranged from 3.2 kg to 38.0 kg with the median weight of 6.0 kg. Nine cases were simple aortic arch lesions, while 34 cases were associated with 2 or more complex cardiac anomalies. The cases were divided into groups according to the age and residence time in ICU. Results The median duration of mechanical ventilation was 23 hours and the median duration of residence time in ICU was 3 days. There were 3 postoperative deaths. Infants younger than 6 months needed more time of mechanical ventilation and longer ICU stay than children older than 6 months. The single factor analysis revealed that young age,low weight, combined with complex cardiac anomalies, and long time of cardiopulmonary bypass and mechanical ventilation were risk factors of prolonged stay in ICU. Postoperative complications occurred in 15 cases：12 cases had the pulmonary infection,5 cases had systemic capillary leak syndrome,2 cases had tracheal stenosis, and 2 cases had low cardiac output syndrome. Extracorporeal membrane oxygenation support and cardiopulmonary resuscitation were guarantees of successful operation of low cardiac output syndrome. Conclusions Outcomes of repair of aortic arch lesion were good, so timely operation should be preformed for aortic arch lesions infants with associated cardiac anomalies,but there is risk of operation and infants need longer duration of ICU stay and tend to have more postoperative complications. The preliminary experiences suggested that it would he better for the children older than 6 months with aortic arch lesion to undertake operation as they tend to have less postoperative complications.