高原地区经右腋下小直切口心脏不停跳心内直视手术的初步经验

PRELIMINARY EXPERIENCE OF OPEN HEART SURGERY WITH BEATING HEART THROUGH SUBAXILLARY THORACOTOMY AT HIGH ALTITUDE

目的 :评价高原地区采用经右腋下小直切口心脏不停跳技术治疗先天性心脏间隔缺损合并肺动脉高压的早期效果 ;方法 :回顾性分析 2 0 0 1年 6月至 2 0 0 1年 9月在海拔 3 70 0m手术治疗的先天性心脏间隔缺损患者 1 0例 ,其中藏族 6例 ,世居西藏地区的汉族 4例 ;年龄 3岁～ 1 1岁 ,平均 7.4岁～ 2 .3岁 ;继发孔型房间隔 (ASD) 5例、室间隔缺损(VSD) 4例、VSD合并ASD1例 ;合并中度以上三尖瓣关闭不全 6例 ;合并轻度肺动脉高压2例 ,中度肺动脉高压 6例 ,严重肺动脉高压 2例 ;均经右腋中线纵向小切口 ,在浅低温、中度血液稀释体外循环下施行手术。采用心脏不停跳技术 ,行ASD修补术 5例、VSD修补6例 ,其中直接缝合 5例、补片修补 1例 ,三尖瓣改良DeVega成形术 6例 ;结果 :无早期死亡。均未出现心、肺和神经等系统严重的并发症 ;出院时经超声心动图检查未发现残余漏 ;术后 7天～ 1 0天均痊愈出院 ;结论 :高原地区采用经右腋下小直切口心脏不停跳技术 ,施行先天性心脏间隔缺损心内直视修补手术 ,能减轻缺血再灌注损伤 ,而且切口隐蔽、美观 。

OBbjectives:To evaluate the early outcome of surgical intervention of congeital heart septal defect under cardiopulmonary bypsaa(CPB) with beating heart via subaxillary thoracotomy at high altitude.Methods:Ten including 5 cases of secundum atrial septal defect(ASD),4 of ventricular septal defect(VSD)and 1 of concomitant VSD and ASD,underwent operative repair between June 2001 and September 2001 in Lhasa at an altiude of 3 700m,eters.There were 6 Tibetan and 4 Tibetan-born Hans with a mean age of 7.41 years (3～11 years).Mild pH,whereas moderate pH and severe pH were found in 2,and 2 seperately.The perioperative arterial oxygen saturation ranged between 84%～92%(mean 88.9%).All patients received surgical repair under moderate hemodilutional and tepid CPB with beating heart through subaxillary vertical thoracotomy.ASD repair was performed in 6 patients and VSD repair in 5,including four casese of direct closure and one of patch repair.Concomitant modified De Vega's tricuspid annuloplasty was done in 6 patients.Rrsults:There was no operative death.All patients were early extubated within six hours of arrival at the intrnsive care unit.No significant postoperative cardiac,pulmonary or neurlolgical complications occurred.The patients were discharged 7～10 days after operation.Neither residual VSD nor ASD has been documented by echocardiographic evaluation at the discharge.Conclusion:Surgical repair of congenital heart septal defects under tepid CPB with beating heart therough subaxillary vertical thoracotomy can achieve a satisfied early clinical outcome at the high altitude with a better cosmetic appearance.