摘要
目的分析动脉调转术治疗新生儿大动脉转位（D-TGA）围术期心肌损害和临床结果。方法．行动脉调转术治疗D-TGA新生儿21例，手术年龄2～28d；体重2．90～4．12kg。分为急诊组9例和非急诊组12例。分别检测术前（T1）、主动脉开放后10min（T2）、术后即刻（T3）、术后24h（T4）、48h（T5）、72h（T6）时心肌肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）的含量，并收集围术期临床资料。结果无手术死亡，急诊组1例术后出现多器官功能衰竭，后放弃治疗。急诊组较非急诊组T1、T2、T3时cTnI增高，两组间CK-MB差异无统计学意义；T2时cTnI浓度与主动脉阻断时间呈正相关（r=0．547，P〈0.01），CK-MB与主动脉阻断时间无明显相关性；急诊组和非急诊组的术后呼吸机辅助时间[（167．78±66．94）h和（75．25±46．11）h]、监护时间[（11．67±4．30）d和（7．67±3．33）d]、术后住院时间[（16．56q±5．36）d和（11．92±3．60）d]差异有统计学意义。结论新生儿D-TGA行动脉调转术治疗效果满意。早期诊断、术前纠正酸中毒、维持动脉导管开放、积极改善术前一般情况、尽量减少急诊手术，可减少术后呼吸机辅助时间、监护时间和术后住院时间，有利病儿术后迅速康复。cTnI、CK-MB是检测心肌损害的指标，cTnI更灵敏，也可作为判断预后的指标。
Objective To assess the perioperative myocardial injury and clinical outcome of the primary arterial switch operation（ASO） for transposition of the great arteries（D-TGA） in neonates. Methods Twenty-one neonates with D-TGA who underwent ASO were enrolled. The age at the operation ranged from 2 to 28 days, and body weight ranged from 2.90 to 4.12 kg. They were ditided into emergency operation group and elective operation group according to their preoperative condition. Serum cardiac troponin I （eTnI） and ereatine kinase-MB （CK-MB） levels were measured at the following time points： T1 （before operation）, T2 （10 minutes after aortic opening）, T3 （ after operation ）, T4 （ 24 h after operation）, T5 （48 h after operation ） and T6 （72 h after operation ） respectively. The data of perioperative clinical outcome were also collected. Results There was no postoperative mortality. One neonate in emergency operation group who developed multiple organ failure （MOF） refused treatment afterwards. The eTnI levels at T1, T2 and T3 in emergency operation group were higher than that in elective operation group. As for the CK-MB levels, there were no statistical difference between the two groups. The cTnI level at 10 minutes after aortic opening correlated with the aortic damping time（ r = 0.647, P 〈 0.01 ） while there were no relationship between CK-MB levels and the aortic clamping time. There were significantly differenees in ventilation duration [ （ 167.78 ± 66.94） h versus （75.25 ± 46.11 ）h], ICU stay [ （11.67 ± 4.30） d versus （7.67 ± 3.33）d] and postoperative stay [ （ 16.56 ± 5.36） d versus （ 11.92 ± 3.60 ）d ] between emergency operation group and eleefive operation group. Conclusion The effect of ASO on treatment of D-TGA in neonates was well accepted. Early diagnosis, correcting of acidosis, keeping PDA patent before operation, and improving of baby condition actively and avoiding emergency operation possibly can reduce postoperative ventilation
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2008年第6期363-366,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
大血管错位
心脏外科手术
婴儿
新生
心肌
Transposition of great vessels Cardiac surgical procedures Infant, newborn Myocardium
