肺动脉闭锁合并室间隔缺损患者应用流量研究的临床结果

The clinical outcomes of applying flow study in patients with pulmonary atresia and ventricular septal defect and major aortopulmonary collateral arteries

目的回顾分析肺动脉闭锁(PA)合并室间隔缺损(VSD)同时伴有粗大体肺侧枝(MAPCAs)患者使用流量研究的临床结果。方法收集整理阜外医院2016年1月至2020年12月期间,术前诊断PA/VSD/MAPCAs并且在术中进行流量研究的患者资料,统计分析患者一般情况,术中肺动脉压力以及术后并发症。结果共有29例患者接受流量研究实验,其中男性11例,女性18例。平均体质量为(11.42±3.41)kg,平均年龄(33.38±20.17)月。9例患者平均肺动脉压(31.11±4.51)mmHg,进行了室间隔开窗(5 mm)。20例患者平均肺动脉压(15.95±4.67)mmHg,完全修补了室间隔缺损。再次气管插管患者平均肺动脉压测量值高于一次气管插管组,机械通气时间显著延长。结论流量研究技术可以预测PA/VSD/MAPCAs根治手术中是否需要VSD开窗,开窗患者术后发生二次气管插管明显增加,应予以重视。流量研究需要体外循环灌注师完善术前准备,熟悉手术流程,术中精细管理,才能保证患者手术安全。

Objective We retrospectively analyzed the clinical results and complications of applying flow study in patients with pulmonary atresia and ventricular septal defect and major aortopulmonary collateral arteries(PA/VSD/MAPCAs)during cardiopulmo⁃nary bypass(CPB).Methods Patients with PA/VSD/MAPCAs enrolled in flow study during CPB were collected from January 2016 to December 2020.The mean pulmonary artery pressures(mPAP)in flow study and the complications were analyzed.Results A total of twenty-nine patients underwent flow study during operations including 11 males and 18 females,with a median age of 33 months and an average body mass of 11.42±3.41 kg.Twenty patients achieved VSD closure(mPAP 15.95±4.67 mmHg)and nine patients'VSD were closed with salvage VSD fenestration(mPAP 31.11±4.51 mmHg).One patient died of pulmonary hypertensive crisis.Five pa⁃tients underwent re-intubation in ICU.Conclusion The flow study was an effective procedure in patients with PA/VSD/MAPCAs.We shoud be more cautious for patients with VSD fenestration.It is challenging for perfusionists to improve preoperative preparation,be fa⁃miliar with surgical procedures,and conduct good management during surgery,so as to ensure the surgical safety of patients.