复杂紫绀型先天性心脏病体-肺动脉分流术后早期并发症及处理措施

Post-operative complications and measures on complex cyanotic congenital heart diseases and pulmonary shunt

目的分析复杂紫绀型先天性心脏病体．肺动脉分流术后早期并发症发生原因及处理方法。方法回顾性分析212例复杂紫绀型先天性心脏病患儿施行升主动脉到肺动脉干的中心分流手术的临床资料，探讨术后早期并发症及相关处理措施。结果术后早期出现并发症61例（28．77％），其中严重低心排出量综合征27例，急性肺水肿14例，24h内分流管道堵塞12例，室上性心动过速8例。术后平均随访时间（2．49±1．21）年，术后所有患儿肺血管发育均明显生长，其中8例（3．77％）肺血管发育较差者经介入体肺侧支封堵后改善。至随访结束，77例患儿达到根治标准，根治率为36．32％。结论术前积极改善心脏功能，严格掌握手术适应证；合理的手术方法；及时纠治并发症；加强术后监护及综合治疗均为提高该手术成功率的因素。

Objective To analyze the causes and treatment methods of early complications after central systemic-pulmonary shunt in complex cyanotic congenital heart diseases. Methods Two hundred and twelve cases of central systemic-pulmonary shunt in complex cyanotic congenital heart diseases were retro- spectively analyzed in order to explore the early postoperative complications and related treatment measures. Results There were 61 cases （28.77 % ） of the early postoperative complications,including severe low cardiac output syndrome in 27 cases, acute pulmonary edema in 14 cases,24 h shunt pipe blockage in 12 cases, and supraventricular tachycardia in 8 cases. All patients got followed up, average for（ 2.49 ± 1.21 ） years. Af- ter the systemic-to-pulmonary artery shunts, pulmonary vascular had significant growth, 8 patients （ 3.77% ） of them who pulmonary hypoplasia were promoted by transcatheter aortopulmonary collateral vessels. At the end of the follow-up,77 patients（36. 32% ） achieved the standard of radical surgery. Conclusion The factors affecting surgical survival rate include：enhancement of patients cardiac function and strictly handle operation indication before operation a clear operational view ; rational surgical methods ; treatment of complication without delay;strict, intensive care and synthesized treatment.