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一个半心室矫治的手术适应证及治疗方法 被引量:1

Indications and procedures of one and a-half ventricular repair
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摘要 目的探讨一个半心室矫治术治疗复杂先天性心脏病的适应证及术式。方法21例先天性心脏病患儿根据心脏畸形不同分为3组,A组11例为Ebstein畸形或三尖瓣狭窄性病变者,B组4例为右心发育不良患儿,C组6例为其他复杂心脏畸形。3组均在低温体外循环下行心内畸形矫正+上腔静脉一肺动脉吻合术。比较各组体外循环时间、主动脉阻断时间、呼吸机辅助时间、ICU时间和胸腔引流量等。结果C组体外循环时间、主动脉阻断时间、呼吸机辅助时间、1cU时间较A、B组长,但组间比较差异均无统计学意义(P〉0.05);C组术后1~3d胸腔引流总量[(1148士403)mL/m2]大于A组[-(676±518)mL/m2]和B组E(338±175)mL/m2],A、B组比较差异无统计学意义(P〉O.05);术后A、B组无死亡病例,C组死亡2例;B组无并发症发生,A组发生心包积液2例、室上性心律失常1例,C组发生感染2例、低心排出量综合征1例;3组术后超声心动图检查均未见上腔静脉肺动脉吻合口狭窄,A组发生三尖瓣少量反流3例及中量反流1例;3组左室射血分数比较差异无统计学意义(P〉O.05)。结论一个半心室矫治术可作为右心室结构及功能异常的Ebstein畸形或右心发育不良者理想术式,但对肺动脉发育不良的复杂先天性心脏病需谨慎选择该术式。 Objective To explore the indications and procedures of one and a-half ventricular repair for complex congenital heart disease.Methods Twenty-one patients with complex congenital heart disease were divided into group A(n=11)with Ebstein's anomaly or tricuspid valve stenosis associated disease,group B(n=4)with hypoplastic right ventricle and group C(n=6)with other kinds of complex heart disease.The patients in all groups accepted heart malformation correction and superior vena cava-pulmonary artery anastomosis under extracorporeal circulation.Intracardiac malformations were corrected with mild hypothermia extracorporeal circulation. The durations of extracorporeal circulation,cross clamp and ventilating,ICU stay and the volume of chest tube drainage were compared among groups.Results The durations of extracorporeal circulation,cross clamp and ventilating as well as ICU stay were longer in group C than those in group A and group B,but there were no significant difference among groups(p〈0.05).The volume of chest tube drainage was larger in group C((1 148±403)mL/m2)than that in group A((676±518)mL/m2)and group B((338±175)mL/m2)in 1to 3days after operation,and there was no significant difference between group A and group B(p〈0.05).Two patients died in group C,and there was no death in group A and B.The complications included pericardial effusion in 2 patients and supraventricular tachycardia in 1 patient in group A,inflammation in 2and low cardiac output in 1in group C,and no complications occurred in group B.The postoperative ultrasonography showed no anastomosis stenosis between superior vena cava and pulmonary artery,slight tricuspid regurgitation in 3and moderate tricuspid regurgitation in 1in group A.There were no significant differences in left ventricular ejection fraction among three groups(p〈0.05).Conclusion Ebstein's anomaly and hypoplastic right ventricle with abnormal right ventricular function and structure are good candidates for one and a-half ventricular repair,which is not suitable for complex congenital heart disease with hypoplastic pulmonary artery.
出处 《中华实用诊断与治疗杂志》 2015年第6期580-582,共3页 Journal of Chinese Practical Diagnosis and Therapy
基金 首都医科大学基础-临床科研合作基金(13JL26) 首都医科大学基础-临床科研合作基金(11JL50) 国家自然科学基金(81400305) 国家自然科学基金(81371443) 科研基地-科技创新平台项目(PXM2011_014226_07_000060) 北京市自然科学基金(7152045) 北京市自然科学基金(122056) 北京市自然科学基金(7142049) 北京市自然科学基金(7142137) 北京市优秀人才培养资助项目(20140000204400001) 北京市卫生局高层次人才培养资助项目(2014-3-043)
关键词 先天性心脏病 一个半心室矫治 EBSTEIN畸形 右心发育不良 Congenital heart disease one and a-half ventricular repair Ebstein's anomaly hypoplastic right ventricle
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