Fontan术后的抗凝管理策略及并发症的预防和治疗

Anticoagulation management strategies and prevention and treatment of thromboembolism in Fontan patients

Fontan手术是将静脉血流直接引入肺动脉,降低单一心室的容量负荷,提高体循环氧合浓度的一类手术方式的总称。该术式自开展以来经过多次改良被广泛用于治疗功能性单心室的复杂紫绀型先天性心脏病患儿。血栓栓塞是Fontan术后的重要并发症之一,也是影响患者远期预后的主要问题。Fontan患者术后血栓形成和栓塞的发生率高,临床危害大,但针对该情况的预防、检查及治疗策略等仍存在争议,尚未达成共识。本文将Fontan术后血栓栓塞并发症的成因、预防、检查及治疗策略作一综述,旨在为提高Fontan患者的远期生存质量提供治疗参考。

Fontan operation aims to lead the systemic venous blood flow directly to the pulmonary artery,and to reduce the volume load of functional single ventricle and increase systemic circulation oxygenation.Different variants of the original Fontan operation have evolved to treat multiple complex cyanotic congenital heart diseases.One of the most important complications after Fontan surgery is thromboembolism,which is also a major factor affecting the long-term prognosis.The incidence of postoperative thrombosis and thromboembolism in Fontan patients is high and seriously affects the prognosis of patients.However,there are still controversies regarding the postoperative prevention,examination and treatment of thromboembolism.This article reviews the causes,prevention,examination,and treatment strategies of thromboembolism in Fontan patients,aims to guide the therapeutic decision and improve the long-term quality of life.