复杂先天性心脏病患儿54例体肺分流术后并发症分析

Analysis of complications of pulmonary shunt in 54 children with complex congenital heart disease

目的观察复杂先天性心脏病体肺分流术后主要并发症发生情况,并探讨其防治方法。方法回顾性分析2010年12月—2014年3月河北医科大学第一医院心外科诊治的54例重度肺血管发育不良的发绀型复杂先天性心脏病患儿的临床资料,其中男29例,女25例,月龄4~72（19.7±11.3）月,体质量5~20（9.4±3.5）kg。根据自身的肺动脉发育情况选择体肺分流姑息手术治疗,其中改良B-T分流术4例,主动脉一主肺动脉分流术18例,主动脉一右肺动脉分流术32例。术后根据年龄、体质量及肺血管发育选择人工分流管道,其中采用4 mm管道20例,采用5咖管道32例,采用6 mm管道2例。结果 54例患者术中无死亡,术后死亡3例（5.6%）。术后主要并发症：低氧血症5例（9.3%）,其中4例为人工分流管道失效（7.4%）、1例灌注肺（1.9%）;肺部感染2例（3.7%）;低心排综合征2例（3.7%）;心律失常3例（5.6%）;肢体活动障碍1例（1.9%）。结论复杂先天性心脏病体肺分流术是一种安全的手术方式,外科手术技术的提高和术后监护经验的积累有助于进一步降低并发症发生率。

Objective To observe the complications of pulmonary shunt for complex congenital heart disease,and to discuss the prevention and treatment.Methods From December 2010 to March 2014,54 cases of severe pulmonary vascular dysplasia of cyanotic complex congenital heart disease patients who treated in First Hospital Department of Cardiac sargery,Hebei Medical University of were enrolled,respectively analyzed the clinical data,which male was 29 cases,25 cases were female,aged 4-72（19.7±11.3） months,body weight of 5- 20（9.4 ± 3.5） kg.According to the development of the pulmonary artery to choose the pulmonary shunt palliative surgery,including 4 cases of modified B-T shunt,aorta and main pulmonary artery shunt in 18 cases,32 cases of aorta and right pulmonary artery shunt,postoperative according to age,body weight and pulmonary vascular development to choose the artificial diversion pipeline,the pipeline of 4 mm in 20 cases,5 mm pipeline in 32 cases,6 mm pipes in 2 cases.Results There were no deaths during operation,after operation,died of three cases（5.6%）.The main postoperative complications：hypoxemia in five cases（9.3%）,including four cases of artificial diversion pipeline failure（7.4%）,one case of lung perfusion（1.9%）;pulmonary infection in 2 patients（3.7%）.Low cardiac output syndrome in two cases（3.7%）,arrhythmia in three cases（5.6%）.Limb movement disorder in 1 case（1.9%）.Conclusion Complex congenital heart disease pulmonary shunt is a safe operation,it can improve the surgical technique and postoperative care experience accumulation of help to further reduce the incidence of complications.