体肺分流术对大龄复杂先天性心脏病患儿的治疗效果

Efficacy of systemic-pulmonary shunt in elder children with complex congenital heart disease

目的探讨体肺分流术对大龄复杂先天性心脏病患儿的治疗效果。方法选取2010年3月至2014年6月在首都医科大学附属北京安贞医院小儿心脏中心接受体肺分流术的大龄（〉3岁）复杂先天性心脏病患儿60例，回顾性分析其围术期一般指标、术后氧合改善和肺动脉发育情况。结果60例患儿中2例术后死亡（3．3％），余58例患儿的经皮血氧饱和度由术前的（72±9）％升高到出院时的（84±15）％。随访15～63个月，22例行进一步手术（36．7％），未手术病例McGoon值由术前的（0．9±0．3）上升到（1．2±0．3）（P〈0．05）。多因素分析提示年龄≤5岁和肺动脉有前向血流可促进肺动脉发育（P〈0．05）。结论体肺分流术可升高肺动脉发育不良大龄患儿的术后血氧饱和度，促进肺动脉发育，年龄≤5岁和肺动脉有前向血流患儿效果更好。

Objective To investigate the therapeutic effect of systemic-pulmonary shunt on complex congenital heart disease in elder children. Methods Sixty children（ 〉 3 years old） with complex congenital heart disease who had systemic-pulmonary shunt from March 2010 to June 2014 in Beijing Anzhen Hospital, Capital Medical University were respectively enrolled. General perioperativc indexes and postoperative pulmonary artery oxygen saturation were analyzed. Results Two children（ 3.3% ） died after operation. Percutaneous blood oxygen saturation was （72 ± 9）% in 60 children before operation and （84 ± 15 ）% in 58 children at discharge. Twenty- two children （36. 7% ） had secondary operations during postoperative 15-63 months; the McGoon value in 36 patients who did not have secondary operation was （0.9 ± 0.3 ） before primary operation and （ 1.2 ± 0.3 ） at the final follow-up（P 〈0.05）. Multivariate analysis showed that ±〈5 years old and forward flow in pulmonary artery were positive factors of pulmonary artery growth after operation（ P 〈 0.05 ）. Conclusion Systemic-pulmonary shunt can increase blood oxygen satnration and promote pulmonary artery growth in eider children with hypoplastic pulmonary artery; ≤5 years old and forward flow in pulmonary artery are positive factors of pulmonary artery growth.