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[1]李晓勇 许铭 宋来春 金晶.131例右心室流出道重度狭窄的先天性心脏病行手术矫治的疗效分析[J].国际心血管病杂志,2019,06:376-379.
　LI Xiaoyong,XU Ming,SONG Laichun,et al.Effect of surgical correction for congenital heart disease in 131 patients with right ventricular outflow tract obstruction[J].International Journal of Cardiovascular Disease,2019,06:376-379.
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131例右心室流出道重度狭窄的先天性心脏病行手术矫治的疗效分析(PDF)

《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:
2019年06期
页码:
376-379
栏目:
临床研究
出版日期:
2019-12-31

文章信息/Info

Title:
Effect of surgical correction for congenital heart disease in 131 patients with right ventricular outflow tract obstruction
作者:
李晓勇 许铭 宋来春 金晶
430022 武汉科技大学附属武汉亚洲心脏病医院; 武汉科技大学职业危害识别与控制湖北省重点实验室
Author(s):
LI Xiaoyong;  XU Ming;  SONG Laichun;  Jin Jing
Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan 430022, China
关键词:
先天性心脏病;  右心室流出道狭窄;  舒张功能不全;  并发症
Keywords:
Congenital heart disease;  Right ventricular outflow tract obstruction;  Diastolic dysfunction;  Complication
分类号:
-
DOI:
10.3969/j.issn.1673-6583.2019.06.013
文献标识码:
-
摘要:
目的:观察外科畸形矫治术对右心室流出道重度狭窄的先天性心脏病的疗效。方法:2013年1月～2018年12月,131例右心室流出道重度狭窄的先天性心脏病患者在武汉亚洲心脏病医院行外科矫治手术,其中男性88例,女性43例,中位年龄4.8岁(2个月～17岁),体质量13.6kg(3.7kg～41.0kg)。所有患者均在全麻、体外循环下行心脏畸形一期矫治术。结果:患者平均手术时间为(166±43)min,体外循环时间(55±23)min,主动脉阻断时间(25±11)min。术后发生低心排综合征37例(28.2%),其中延迟关胸4例,房间隔留孔11例,急诊行体肺分流术2例。根据术后中心静脉压(CVP),分为高CVP组和低CVP组,前者血管活性药物剂量和呼吸机使用时间低于后者(P均<0.05)。随访时间6～54个月(中位数28个月),均为纽约心脏病协会(NYHA)心功能分级Ⅰ～Ⅱ级。在房间隔留孔的11例患者中,5例在1年内转为左向右分流。结论:右心室流出道重度狭窄的先天性心脏病患者行手术矫治的风险高,右心室舒张功能不全是血流动力学的主要特点,维持较高的容量负荷有助于患者度过围术期。
Abstract:
Objective:To investigate the efficacy of surgical correction for congenital heart disease with right ventricular outflow tract obstruction.Methods:A total of 131 patients with severe stenosis of right ventricular outflow tract who underwent operation from January 2013 to December 2018 were included. There were 88 males and 43 females. The median age was 4.8 years old(2 months to 17 years old). The median body weight was 13.6 kg(3.7 kg to 41.0 kg). All the patients underwent one-stage surgical correction of cardiac malformation under general anesthesia and cardiopulmonary bypass.Results:The average operational time was(166±43)min, and the cardiopulmonary bypass time was(55±23)min. The mean aortic cross clamp time was(25±11)min. Thirty-seven(28.2%)patients suffered from postoperative low cardiac output syndrome including 4 cases of delayed sternal closure, 11 cases of atrial septal defect and 2 cases of emergency Blalock-Taussig shunt. According to the central venous pressure(CVP)after operation, the patients were individed into two groups, namely high CVP group and low CVP group. Compared with the low CVP group, dose of vasoactive drugs in the high CVP group was lower with shorter ventilator use time(P all <0.05). The median follow-up time was 28 months(range from 6 to 54 months). All the patiens were in New York Heart Association(NYHA)functional class Ⅰ to Ⅱ. Among the 11 patients with atrial septal defect there were 5 patients turned into left-to-right within one year.Conclusions:The surgical correction of congenital heart disease with right ventricular outflow tract obstruction is high-risk. The right ventricular diastolic dysfunction is the main characteristic of hemodynamics. Maintaining a high volume load is helpful to pass through the perioperative period.

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备注/Memo

备注/Memo:
基金项目:湖北省卫生健康科研基金(WJ2018H0100、WJ2019H238); 武汉市卫生计生科研基金(WX18Q33、WX19Y21); 武汉中青年医学骨干人才培养工程
作者单位:430022 武汉科技大学附属武汉亚洲心脏病医院; 武汉科技大学职业危害识别与控制湖北省重点实验室
通信作者:金晶,Email:jjgf801206@sina.com
更新日期/Last Update: 2019-12-27