呼吸对肺动脉下腔静脉直接连接术的远期血流动力学影响

Effect of respiration on hemodynamic results of extracardiac conduit in modified extracardiac Fontan operation with direct cavopulmonary connections

目的探讨呼吸对肺动脉下腔静脉直接连接（direct cavopulmonary connections,DCPC）术患儿的心外管道远期血流动力学的影响。方法收集并分析2005年7月至2013年12月期间,在广东省人民医院行DCPC术的患儿的临床及超声随访资料。结果共19例入组,男11例,女8例,年龄（7.3±0.9）岁,随访时间（5.52±2.83）年。一期手术12例,二期手术7例;均在体外循环下进行。9例进行主动脉阻断（2例行二期DCPC手术,7例行一期DCPC手术）,中位阻断时间69（47~119）min。随访时,下腔静脉直径（diameter of inferior vena cava,Divc）和上腔静脉平均流速（velocity of superior vena cava,Vsvc）较术前缓慢,差异有统计学意义（P〈0.05）;上腔静脉直径（diameter of superior vena cava,Dsvc）和下腔静脉平均流速（velocity of inferior vena cava,Vivc）与术前比较,差异无统计学意义（P〉0.05）。Vivc受呼吸影响,吸气时相与呼气时相Vivc比较,差别具有统计学意义（P〈0.05）。Vsvc不受呼吸影响,吸气时相与呼气时相Vsvc比较,差异无统计学意义（P〉0.05）。结论呼吸影响DCPC患者心外管道的血流,产生的搏动性血流更利于自体管道的生长,改善了患者的远期生存。

Objectives To investigate the effects of respiration on long-term hemodynamic results of extracardiac conduit in modified extracardiac Fontan operation with direct cavopulmonary connections（DCPC）. Methods The clinical and ultrasound follow-up data of DCPC patients were collected from July 2005 to December 2013 in Guangdong General Hospital and analyzed retrospectively. Results Totally 19 consecutive patients who underwent extracardiac Fontan with DCPC in Guangdong General Hospital were enrolled, including 11 males and 8 females aged（7.3±0.9） years. Rate of follow-up was 100%. Mean follow-up duration was（5.52 ±2.83） years. Twelve patients underwent one-stage DCPC and 7 patients underwent two-stage DCPC. All DCPC were done by cardiopulmonary bypass（CPB） and aortic cross-clamps were necessary in 9 patients（2 in two-stage DCPC and 7 in one-stage DCPC）. Median duration of aortic cross-clamping was 69（47-119） min. There were significant differences between postoperative and follow-up data in diameter of inferior vena cava（Divc） and velocity of superior vena cava（Vsvc）, but no significant difference in diameter of superior vena cava（Dsvc） and velocity of inferior vena cava（Vivc）. Vivc was affected by respiration： Vivc between inspiratory phase and expiratory phase had significant differences（P〈0.05）. Vsvc was not affected by respiration： Vsvc between inspiratory phase and expiratory phase had no significant difference（P〉0.05）. Conclusions Effects of respiration on hemodynamic results of extracardiac conduit in patients with DCPC are significant. Pulsatile forward flow caused by respiration is more beneficial to the growth of autologous vessels, which improves the long-term survival of DCPC patients.