不同年龄法洛四联症根治手术的围术期临床结果

Radical operation on Tetralogy of Fallot and its perioperative outcomes in different ages

目的分析不同年龄婴儿与儿童法洛四联症根治手术的围术期临床结果，探讨早期外科治疗的可行性及优越性。方法分析2007年1月至2014年1月郑州大学第三附属医院心外科行法洛四联症根治手术的390例患儿临床资料。年龄3个月-14岁，平均年龄3岁。其中婴儿组（〈1岁）172例，儿童组（≥1岁）218例。伴发畸形：房间隔缺损33例、动脉导管未闭17例、冠状动脉畸形8例、多发室间隔缺损5例。结果本组死亡10例，总死亡率2．56％，婴儿组与儿童组死亡率分别是2．32％（4／172例）和2．75％（6／218例），2组比较差异无统计学意义（Х^2=0．000，P=1．000）。婴儿组和儿童组体外循环时间分别为（89．16±74．38）min、（83．14±66．72）min，主动脉阻断时间分别为（59．75±35．20）min、（54．70±38．54）min，手术时间分别为（185．34±168．64）min、（163．35±150．15）min，术后呼吸机辅助时间分别为（57．17±67．46）h、（47．50±58．39）h，重症监护室监护时间分别为（5．08±7．93）d、（3．71±5．40）d，术后住院时间分别为（13．82±17．78）d、（9．52±8．74）d，2组问比较差异均无统计学意义（t=1．937、1．890、1．991、1．887、1．951、1．931，P=0．259、0．713、0．194、0．739、0．241、0．308）。结论婴儿法洛四联症早期行外科手术治疗安全、可靠，并发症少，死亡率低；可避免因治疗较晚导致患儿生长发育落后、缺氧发作、甚至猝死等不良事件。

Objective To explore the feasibility and advantages of early open -heart radical operation on infants and children with Tetralogy of Fallot（TOF） in different ages and to analyze its perioperative outcomes. Methods The clinical data of 390 infants and children with TOF were analyzed, who underwent extracorporeal circulation open -heart surgery from January 2007 to January 2014 at the Department of Cardiovascular Surgery, the Third Affiliated Hospital of Zhengzhou University. The operative age ranged from 3 months to 14 years（ mean 3 years）. There were 172 infants（ 〈 1 year old）and 218 children（ ≥ 1 year old）. Some accompanied abnormalities included atrial septal defect （33 cases）, patent ductus arteriosus （17 cases）, coronary artery anomalies （8 cases ）, and multiple ventricular septal defect （5 cases）. Results Ten patients died, and the overall mortality during hospital stay was 2.56%. The mortality of the infants group and the children group was 2.32 % （4/172 cases ） and 2.75 % （ 6/218 eases ）, respectively, and there was no significant difference （Х^2 = 0. 000, P = 1. 000 ）. Extracorporeal circulation time was （89. 16 ±74. 38） rain and （ 83.14 ±66.72 ） min, respectively, aortic clamping time was （ 59.75 ±35.20） min and （ 54.70 ±38. 54 ） min respectively, operation time were （ 185.34 ±168.64 ） min and （ 163.35 ±150.15 ） min respectively, duration of postoperative ventilation were （57.17 ±67.46） h and （47.50 ±58.39） h, respectively, the hospitalization time in the Intensive Care Unit was （5.08 ±7.93） d and （3.71 ±5.40） d, respectively, and the postoperative stay averaged （ 13.82 ±17.78） d and （9.52 ±8.74） d respectively in the infants group and the children group ; there was no significant differences between 2 groups （ t = 1. 937,1. 890,1.991,1. 887,1.951,1.931 ; P = 0. 259,0.713,0. 194, 0. 739,0.241,0. 308 ）. Conclusions The curative effect of early cardiac surgical treatment on infants with TOF is considerably good with low morbidity and mortality. Early cardiac surgical treatment can avoid delayed development and growth in children, hypoxemie spells, sudden death and some other kind of adverse events.