Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival ...Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs,analyses of the distribution of blood flow from superior venous cava(SVC) and inferior venous cava(IVC)and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.Results. GroupⅠ:The flow ratio of the IVC to left lung was greater than that to the right lung,P≤0.01;the flow ratio of the SVC to right lung was greater than that to the left lung,P≤0.01;and the whole pulmonary blood flow went dominantly to the left lung,P≤0.05,which is not in line with physiological distribution. GroupⅡ:the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs,the whole pulmonary blood flow went to both lungs,P≥0.05. Group Ⅲ:the flow ratio of the SVC to both lungs were the same,P≥0.05,and major part from IVC went to the right lung,P≤0.01;the pulmonary blood flow go dominantly to the right lung,P≤0.05,which is in accord with physiological distribution. Group Ⅳ:the flows from the right SVC went to right lung by 100%,P≤0.01,and that from the left SVC went to left lung by 100% too,P≤0.01;the flows from IVC went dominantly to the left lung,with little part to the right lung ,P≤0.05.Conclusions. Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava(PLSVC).展开更多
目的探讨单中心Stanford A型主动脉夹层(TAAD)患者术后死亡及严重并发症的独立危险因素。方法回顾性分析2012年5月至2015年5月阜外医院行手术治疗341例TAAD患者的临床资料,其中男246例、女95例,平均年龄29~73(47.42±11.54)岁。根...目的探讨单中心Stanford A型主动脉夹层(TAAD)患者术后死亡及严重并发症的独立危险因素。方法回顾性分析2012年5月至2015年5月阜外医院行手术治疗341例TAAD患者的临床资料,其中男246例、女95例,平均年龄29~73(47.42±11.54)岁。根据术后有无出现死亡或严重并发症将患者分为两组:并发症组(87例)和无并发症组(254例)。比较分析两组患者围术期资料。结果并发症组患者平均年龄显著高于无并发症组患者[(49.91±11.22)岁vs.(46.57±11.54)岁,P=0.019]。并发症组患者术前出现器官缺血性损伤比例显著高于无并发症组患者:脑缺血(18.4%vs.5.9%,P=0.001)、脊髓损伤(16.1%vs.4.7%,P=0.001)、急性肾损伤(31.0%vs.10.6%,P=0.000)。夹层累及动脉分支血管比例显著高于无并发症组患者:冠状动脉受累(52.9%vs.17.1%,P=0.000)、弓上动脉受累(73.6%vs.53.9%,P=0.001)、腹腔干动脉受累(37.9%vs.22.0%,P=0.003)、肠系膜上动脉受累(18.4%vs.9.8%,P=0.030)、单侧或双侧肾动脉受累(27.6%vs.9.8%,P=0.000)。并发症组体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于无并发症组[(205.05±63.65)min vs.(167.67±50.24)min,(108.11±34.79)min vs.(90.75±27.33)min,(22.55±8.09)min vs.(18.76±9.56)min,P<0.05]。年龄、术前合并脑缺血性损伤、术前合并急性肾损伤、术前肢体感觉和(或)运动功能障碍、夹层累及冠状动脉、体外循环时间均为TAAD患者术后死亡和严重并发症发生的独立危险因素;对于夹层累及冠状动脉患者而言,积极同期行冠状动脉旁路移植术可显著降低术后出现并发症的风险,是T A A D患者术后并发症的独立保护性因素[OR=0.167(0.060,0.467),P=0.001]。结论探寻TAAD患者术后各种并发症的高危因素,可为术前识别手术高危人群及术后更加积极预防各种并发症提供重要的临床依据。展开更多
文摘Objective.To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC)of different types,and to provide the selection of the best type.Methods. Thirty-two consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in the left and right lungs,analyses of the distribution of blood flow from superior venous cava(SVC) and inferior venous cava(IVC)and the whole pulmonary blood flow in both lungs were made. All patients were divided into 4 groups by the the anastomosis between IVC and pulmonary artery.Results. GroupⅠ:The flow ratio of the IVC to left lung was greater than that to the right lung,P≤0.01;the flow ratio of the SVC to right lung was greater than that to the left lung,P≤0.01;and the whole pulmonary blood flow went dominantly to the left lung,P≤0.05,which is not in line with physiological distribution. GroupⅡ:the flows from the SVC and IVC were mixed in the middle of the junction and ran evenly into the right and left lungs,the whole pulmonary blood flow went to both lungs,P≥0.05. Group Ⅲ:the flow ratio of the SVC to both lungs were the same,P≥0.05,and major part from IVC went to the right lung,P≤0.01;the pulmonary blood flow go dominantly to the right lung,P≤0.05,which is in accord with physiological distribution. Group Ⅳ:the flows from the right SVC went to right lung by 100%,P≤0.01,and that from the left SVC went to left lung by 100% too,P≤0.01;the flows from IVC went dominantly to the left lung,with little part to the right lung ,P≤0.05.Conclusions. Different types of TCPC can result in different pulmonary blood distributions. The best flow distribution between the left and right lungs can be obtained by an offset of the IVC anastomosis toward the RPA with widening anastomosis for the patients without persist left superior venous cava(PLSVC).
文摘目的探讨单中心Stanford A型主动脉夹层(TAAD)患者术后死亡及严重并发症的独立危险因素。方法回顾性分析2012年5月至2015年5月阜外医院行手术治疗341例TAAD患者的临床资料,其中男246例、女95例,平均年龄29~73(47.42±11.54)岁。根据术后有无出现死亡或严重并发症将患者分为两组:并发症组(87例)和无并发症组(254例)。比较分析两组患者围术期资料。结果并发症组患者平均年龄显著高于无并发症组患者[(49.91±11.22)岁vs.(46.57±11.54)岁,P=0.019]。并发症组患者术前出现器官缺血性损伤比例显著高于无并发症组患者:脑缺血(18.4%vs.5.9%,P=0.001)、脊髓损伤(16.1%vs.4.7%,P=0.001)、急性肾损伤(31.0%vs.10.6%,P=0.000)。夹层累及动脉分支血管比例显著高于无并发症组患者:冠状动脉受累(52.9%vs.17.1%,P=0.000)、弓上动脉受累(73.6%vs.53.9%,P=0.001)、腹腔干动脉受累(37.9%vs.22.0%,P=0.003)、肠系膜上动脉受累(18.4%vs.9.8%,P=0.030)、单侧或双侧肾动脉受累(27.6%vs.9.8%,P=0.000)。并发症组体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于无并发症组[(205.05±63.65)min vs.(167.67±50.24)min,(108.11±34.79)min vs.(90.75±27.33)min,(22.55±8.09)min vs.(18.76±9.56)min,P<0.05]。年龄、术前合并脑缺血性损伤、术前合并急性肾损伤、术前肢体感觉和(或)运动功能障碍、夹层累及冠状动脉、体外循环时间均为TAAD患者术后死亡和严重并发症发生的独立危险因素;对于夹层累及冠状动脉患者而言,积极同期行冠状动脉旁路移植术可显著降低术后出现并发症的风险,是T A A D患者术后并发症的独立保护性因素[OR=0.167(0.060,0.467),P=0.001]。结论探寻TAAD患者术后各种并发症的高危因素,可为术前识别手术高危人群及术后更加积极预防各种并发症提供重要的临床依据。
