房室瓣反流对完全腔静脉肺动脉吻合患者的影响

The effects of perioperative recovery after total cavo-pulmonary connection for the patients with atrio-ventricular valves regurgitation

目的 评价心脏房室瓣（Atrio ventricular valves） AVV反流对全腔手术围手术期恢复的影响.方法 回顾性总结2001年6月至2011年6月238例采用Gore-Tex材料心外管道行全腔手术患儿（者）资料.术前通过超声心动图检查患儿（者）是否有AVV反流,并评价AVV反流程度.AVV反流组65例,年龄1.5 ～25.0岁,中位年龄6.3岁;平均体质量19.5 kg;反流轻度42例（64.6％）、中-重度23例（35.4％）.无AVV反流组173例,年龄1.3～31.0岁,中位年龄7.9岁,平均体质量19.0 kg.记录和分析两组患者术后的呼吸机辅助时间、重症监护（ICU）室停留时间、住院天数、并发症等围手术期恢复指标.结果 AVV反流组住院死亡5例（7.69％）,无AVV反流组住院死亡9例（5.20％）;AVV反流组总住院天数、体外循环时间、主动脉阻断时间和胸液引流置管时间明显高于无AVV反流组,两组住院死亡比例、术后平均肺动脉压力、并发症发生率、呼吸机辅助通气时间和胸液引流总量差异无统计学意义.AVV反流组中,中-重度反流患者行AVV成形术者占78.5％,轻度反流与中-重度反流亚组间,患儿（者）围手术期恢复差异无统计学意义.结论 AVV中-重度反流患儿（者）行全腔手术同时AVV成形有利于其术后恢复.需进一步随访评估AVV反流对患儿（者）远期预后的影响.

Objective To evaluate the effects of the existence and degree of preoperative regurgitation of atrio-ventricular valves（AVV） in the patients undergoing total cavo-pulmonary connection（TCPC） with in their perioperative recovery.Methods From June 2001 to June 2011.There were 238 patients undergoing TCPC with Gore-Tex as extracardial conduit.65 cases in the AVV regurgitation group,the median age of this group was 6.3 years（ranged from 1.5 years to 25.0 years）,the mean weight of this group was 19.5 kg,and 42 of them（64.6%） were diagnosed as mild regurgitation of AVV while 23 of them （35.4%） were diagnosed as moderate-severe regurgitation of AVV.There were 173 cases in non-AVV group,the median age of them were 7.9 years（ranged from 1.3 years to 31.0 years）,the mean weight of them were 19.9 kg.The echocardiograms were procedure to evaluate the existence and degree of AVV regurgitation before TCPC,the mechanical ventilation hours,intensive care unitICU） stays,total hospital stays and complications were recorded and analyzed.Results There were 5 patients （7.69%） died in the AVV regurgitation group while 9 （5.20%） in non-AVV Group.The total hospital stays,the cardiopulmonary bypass and aortic clamp time in AVV Regurgitation Group were much higher than those of non-AVV Regurgitation group.However,there were no significant differences in the incidence of complications,the post-operative mean pulmonary pressure and mechanical ventilation hours between the two groups.There weren＆#39; t significant differences between the mild and moderate-severe regurgitation in AVV regurgitation group.Conclusion It showed good perioperative results for the patients with moderate to severe regurgitation of AVV undergoing the early valves plasty at the same time of the TCPC procedures.To evaluate the long term outcomes of the AVV regurgitation patients,the further studies should be followed.