新生儿一期矫治主动脉缩窄合并心内畸形的疗效分析

One-stage repair of aortic coarctation plus intra-cardiac anomalies in neonates

目的探讨新生儿主动脉缩窄合并心内畸形一期手术治疗的方法及效果。 方法收集2015年3月至2017年3月由深圳市儿童医院心胸外科收治的19例主动脉缩窄合并心内畸形患儿作为研究对象,其中12例新生儿主动脉缩窄合并心内畸形患儿行一期矫治术,男童7例,女童5例,年龄(20.5±7.9)d,体重(3.08±0.81)kg;对照组为7例分期接受主动脉缩窄合并心内畸形矫治术的新生儿,其中男童4例,女童3例,年龄(15.7±9.4)d,体重(3.28±0.45)kg。比较两组患儿的体外循环时间、主动脉阻断时间、主动脉弓Z值和主动脉弓术后残余压差。 结果12例一期手术组均采用经胸骨正中切口行一期矫治术,对照组7例行分期矫治术。一期手术组体外循环时间(93.3±16.3)min,明显高于对照组(56.6±9.8)min,差异有统计学意义(t=5.081,P<0.01);一期手术组主动脉阻断时间为(47.3±15.1)min,对照组为(29.3±8.1)min,差异有统计学意义(t=2.768,P=0.01);术后常规随访1~12个月,一期手术组主动脉弓残余压差为(9.84±17.2)mmHg,明显低于对照组(27.3±37.1)mmHg,差异有统计学意义(t=3.499,P<0.01);术后两组患儿上下肢收缩压压差及主动脉弓直径Z值差异均无统计学意义(P>0.05)。术后1年内随访残余梗阻情况一期手术组(9.83±9.69)mmHg低于对照组(34.8±17.03)mmHg,差异有统计学意义(t=2.516,P=0.04)。两组均无临床死亡病例。 结论新生儿期胸骨正中一期矫治主动脉缩窄合并心内畸形具有满意的手术疗效。

Objective To summarize the clinical experience of one-stage of aortic coarctation plus intra-cardiac anomalies in neonates. Methods From March 2015 to March 2017,a total of 19 children of aortic coarctation plus intra-cardiac anomalies were assigned into one-stage ( n =12) and two-stage ( n =7) groups.In one-stage group,repair was performed by median sternotomy.Two groups were compared with regards to cardiopulmonary bypass time,aortic clamping time,ventilator assisted time and duration of intensive care unit (ICU). Results Cardiopulmonary bypass time was longer in one-stage group than that in two-stage group[(93.3±16.3) vs .(56.6±9.8) min].The difference was statistically significant ( t =5.081, P <0.01);aortic clamping time[(47.3±15.1) vs.(29.3±8.1) min].The difference was statistically significant( t = 2.768 , P =0.01).During a routine postoperative follow-up period of 1-12 months,residual pressure gradient of aortic arch was obviously higher in one-stage group than that in two-stage group[(9.84±17.2) vs .(27.3±37.1) mmHg].The difference was statistically significant( t =3.499, P <0.01);However,no statistically significant inter-group differences existed in postoperative value of upper/lower extremity systolic pressure gradient or Z value of aortic arch ( P >0.05).During a postoperative follow-up period of one year,residual stenosis was lower in one-stage group than that in two-stage group[(9.83±9.69) vs .(34.8±17.03)] and the difference was statistically significant ( t =2.516, P =0.04).Neither group had any mortal case.Cardiopulmonary bypass time in one-stage group was higher than two-stage group (102±102 vs .56.6±9.8 min, P <0.05);aortic clamping time had no inter-group difference (49.6±34.9 vs .29.3±8.1 min, P >0.05).During a postoperative follow-up period of 1 to 12 months,residual pressure gradient of aortic arch was lower in one-stage group than that in two-stage group[(9.8±17) vs .(27±37) mmHg, P <0.05] and the difference was statistically significant.No significant inter-group difference existed in pressure gradient of upper/lower extremity or Z value of aortic arch. Conclusion The immediate outcome of one-stage repair of aortic coarctation plus intra-cardiac anomalies is excellent in neonates.