婴幼儿法洛氏四联症根治术的治疗体会

Experience of radical correction for tetralogy of Fallot in infants and young children

目的体会婴幼儿法洛氏四联症根治术的治疗效果。方法随机抽取70例本院自2014年6月~2016年6月收治的先心病婴幼儿作为研究目标,所有婴幼儿均经X线胸片、心脏彩超等确诊为法洛氏四联症,均实施法洛氏四联症根治术治疗,分析治疗效果。结果 70例患儿治疗成功68例,早期死亡2例,术前死亡率2.9%(2/70);全部患儿术中体外循环平均转流(115.3±31.1)分,阻断升主动脉平均(63.9±21.0)分。治疗成功68例婴幼儿中,67例自动复跳,除颤后复跳1例。68例复跳后心律不齐者3例,其中有1例实施缝置临时起搏导线。68例出现胸腔积液2例,残余室间隔缺损2例,低心排综合征2例,实施2次开胸止血1例,一次性三度房室传导阻滞1例,并发症发生率11.8%(8/68);术后40h死亡1例(1.5%)。治疗后婴幼儿心功能指标明显优于治疗前(P<0.05)。结论婴幼儿法洛氏四联症根治术治疗效果显著,临床经验表明,把握好手术机会与麻醉技术,管理好体外循环及护理措施,可进一步提高手术成功几率与临床治疗效果。

Objective To evaluate the effect of radical correction for tetralogy of Fallot in infants and young children.Methods Seventy cases of congenital heart disease in our hospital from June 2014 to June 2016 were randomly selected as the research objects.All infants were diagnosed with tetralogy of Fallot by chest X-ray and echocardiography.They were treated with radical correction of tetralogy of Fallot,and the therapeutic effect was analyzed.Results In 70 cases,68 cases were successfully treated,2 cases died early,and the mortality before operation was 2.9%(2/70);The mean cardiopulmonary bypass The mean bypass of the extracorporeal circulation was(115.3±31.1)in all children,and the mean ascending aorta was(63.9±21.0).In 68 infants,67 cases recovered automatically,1 cases recovered after defibrillation.In 68 cases,3 cases had arrhythmia after repeated beating,and 1 cases underwent temporary pacing lead.In 68 cases,there were 2 cases of pleural effusion,2 cases of residual ventricular septal defect,2 cases with low heart drainage syndrome,1 cases with 2 thoracotomy hemostasis,1 cases with three degree atrioventricular block,and the incidence of complications was11.8%(8/68).1 cases(1.5%)died 40 hours after the operation.After treatment,cardiac function index of infants was significantly better than that before treatment,P<0.05.Conclusion The curative effect of radical correction of tetralogy of Fallot in infants and children is significant.The clinical experience shows that good grasp of surgical opportunity and anesthesia technology,management of cardiopulmonary bypass and nursing measures can further improve the success rate of operation and clinical treatment effect.