新生儿肺动脉闭锁伴室间隔完整的急诊手术早期疗效

Early outcomes of emergency operations in neonates with pulmonary atresia and intact ventricle septum

目的总结新生儿肺动脉闭锁伴室间隔完整(PA/IVS)[含危重型肺动脉狭窄(CPS)]的患儿采用目前常用手术方法进行急诊手术的近期效果,分析影响术后早期疗效的危险因素。方法选择2016年1月至2020年12月在上海儿童医学中心心胸外科接受急诊手术的新生儿PA/IVS和CPS患儿做回顾性研究,术前依据三尖瓣Z值,判断右心室发育状况并选择相应的手术方式。总结术后早期疗效,分析影响近期死亡的危险因素。结果共纳入65例患儿(其中CPS 27例),根据术前解剖条件,分别选择以Blalock-Taussig分流术(B-T分流术)、肺动脉瓣交界切开、右室流出道开通为主的手术治疗方法。全组死亡7例(10.7%),术后氧饱和度有轻度改善,依赖较大剂量血管活性药物。术后早期有9例(13.8%)患儿因低氧或低心排再次手术。多因素Logistic回归分析显示,B-T分流术和多次手术是术后早期死亡的危险因素。结论新生儿PA/IVS和CPS急诊术后早期病死率较高,准确判断右心室发育状态并选择合适的手术方法是成功的关键。B-T分流术和术后早期再次手术是影响手术效果的危险因素。

Objective To study the early outcomes of emergency operation employed with one of the prevalent surgical methods in neonates diagnosed as pulmonary atresia with intact ventricle septum(PA/IVS)and critical pulmonary stenosis(CPS),and to analyze the risk factors related to its early results.Methods A retrospective analysis was conducted to collect the data of neonates suffered from PA/IVS and CPS from January 2016 to January 2020 in cardiothoracic surgery department at Shanghai Children′s Medical Center.According to their Z score,which reflects the development degree of right ventricle,the neonates received one of the relevant popular operations.Early outcomes were summarized and risk factors related to its early stage mortality were analyzed.Results A total of 65 neonates were enrolled,including 27 CPS cases.They were operated on the basis of their respective Z scores,and also according to these data,the primary surgical procedure was chosen from the following methods:Blalock-Taussig(B-T)shunt,pulmonary valvulotomy and right ventricular outlet enlargement.Totally seven cases died,and mortality was 10.7%.Nine cases received re-operation in several following days because of severe hypoxemia and low cardiac output.All patients had mild improvement in oxygen saturation after operation and relied on large dose of inotropic agent.Multivariate Logistic regression analysis showed that B-T shunt and re-operation in early period were risk factors for death in neonates with PA/IVS and CPS.Conclusion There is a higher mortality in neonates who received emergency operation for PA/IVS and CPS.Accurate assessment of the right ventricle development degree and selecting the corresponding appropriate surgical method is critical for the optimal result.B-T shunt and early stage re-operation are the risk factors for death in neonates with PA/IVS and CPS who received emergency operation.