常温体外循环下动脉导管直视闭合术

Direct Closure of Patent Ductus Arteriosus under Normothermia Cardiopulmonary Bypass

目的 寻求更好的动脉导管未闭 (PDA)直视下的闭合方法。 方法 自 2 0 0 1年 2月～2 0 0 2年 12月 ,对 2 0例患者在常温体外循环下行PDA直视闭合术。体外循环开始后 ,切开肺动脉 ,用流出道探子堵住PDA开口后再行直视修补。并与 8例常规深低温低流量下PDA直视闭合术进行比较。结果 常温组与深低温低流量组体外循环时间 (T CPB)、术后呼吸机辅助时间 (T MV)和总胸引流量(TD)分别为 :(4 4 .11± 35 .85 )min、(89.11± 4 0 .2 9)min ;(7.33± 3.0 4 )h、(4 2 .38± 36 .2 8)h ;(6 .30± 1.6 7)ml kg、(9.4 9± 3.84 )ml kg ,两组间有明显的差别 (P <0 .0 5 )。深低温低流量组中有 2例术后超声多谱勒证实PDA修补处有残余分流 ,1例二次开胸止血 ,有 1例并发严重的灌注肺死于肺部感染、呼吸衰竭。常温组无一例残余分流 ,仅 1例超声多谱勒示左肺动脉开口处局限性血流加快。 结论 常温体外循环下用流出道探子堵住PDA开口后行PDA直视闭合术 ,手术效果确切 ,且能缩短体外循环时间 ,降低术后并发症 ,是一种较好的PDA直视修补方法。

Objective To study a more convenient and effective method for direct closure of patent ductus arteriosus(PDA). Methods Of the 28 patients who underwent surgical PDA repair between February 2001 and December 2002, 20 cases were directly repaired under normothermia cardiopulmonary bypass(CPB) and 8 were under CPB at deep hypothermia and low arterial flow. The direct repair was performed through pulmonary artery approach, and in the normothermia group, the PDA was blocked with a dilator before the repair. Results The time of CPB (T-CPB), machinery ventilation (T-MV), and the total drainage(TD) between the two groups were (44.11±40.29)/(89.11±40.29)min;(7.33±3.04)/(42.38±36.28)h;(6.03±1.67)/(9.49±3.84)ml/kg respectively. There were significantly differences between the two groups. In hypothermia group, 2 cases had residual shunts, one had severe pulmonary hypertension and died of pulmonary infection and respiratory failure ten days after operation.In the normothermia group, all patients recovered. Conclusion Normothermia CPB with dilator occlusion is a more convenient and effective method for the direct closure of PDA.