摘要
目的总结外科治疗婴儿法洛四联症(TOF)的临床经验,并对早期、中期疗效进行评价。方法 142例婴儿TOF,术前经心脏彩超和(或)心脏CTA检查确诊,其中男性79例,女性63例;年龄1~12个月,平均(6.4±2.7)个月;体质量3.0~12.0kg,平均(6.7±1.4)kg。McGoon值0.80~2.47,平均1.59±0.34;左室舒张末容积指数14.0~36.3mL/m2,平均(25.5±5.9)mL/m2。138例在中度低温体外循环下行一期根治术,4例行分期根治手术。结果体外循环时间(95.0±21.7)min,主动脉阻闭时间(54.3±15.1)min,术后呼吸机辅助时间(40.2±30.5)h,监护室停留时间(5.0±3.5)d。治愈出院140例,死亡2例(院内死亡率1.4%)。术后二次手术4例(2.8%)。术后并发症主要为低心排出量综合征、肺部感染、急性肾衰竭等,并发症发生率为7.0%(10/142)。随访患儿127例,随访率89.4%,随访时间11~62个月(中位数37个月),均无死亡或再次手术;心功能Ⅰ级117例(92.1%),心功能Ⅱ级10例(7.9%);心脏超声提示右室射血分数(EF)均正常,微量或少量肺动脉瓣反流113例(89.0%),中量反流14例(11.0%),无大量反流。结论婴儿期行TOF根治术是安全有效的,优化手术方法及加强围手术期管理是提高婴儿期TOF手术成功率的关键,术后早期和中期疗效满意。
Objective To summarize the clinical experiences of surgical treatment of tetralogy of Fallot （TOF） in infants, and to evaluate its short- and mid-term efficacy. Methods The clinical data of 142 infants with TOF preoperatively diagnosed by cardiac color Doppler ultrasound and/or cardiac CT angiography were retrospectively reviewed. There were 79 males and 63 females with a mean age of （6.4±2.7） months （range 1-12 months） and a mean body weight of （6.7±1.4） kg （range 3.0-12.0 kg）. The mean McGoon index was 1.59±0.34 （range 0.80-2.47）, and the left ventricular end diastolic volume index was 25.5±5.9 （range 14.0-36.3）. One-stage radical operation was performed in 138 cases under moderate hypothermic cardiopulmonary bypass, and staging radical operation was performed in 4 cases. Results The mean time of cardiopulmonary bypass, arrest of the ascending aorta, post-operative ventilation, and ICU stay were （95.0±21.7） min, （54.3±15.1） min, （40.2±30.5） h, and （5.0±3.5） d, respectively. Two cases died in the early postoperative period, with the mortality being 1.4%. Reoperation in the early postoperative period was performed in 4 cases （2.8%）. The incidence rate of postoperative complications was 7.0% （10/142）, including low cardiac output syndrome, pulmonary infection, acute renal failure and so on. Medium term clinical follow-up was achieved in 127 （89.4%） cases. The mean follow-up time ranged from 11 to 62 months （median 37 months）. There was no death or reoperation during the follow-up period. The cardiac function NYHA classⅠwas found in 117 cases, and class Ⅱ in 10 cases. During the follow-up period, all patients had normal right ventricular ejection fraction, and various degrees of pulmonary regurgitation （PR）, including trace or mild PR in 113 cases （89.0%） and moderate PR in 14 cases （11.0%）. Conclusion Radical operation of TOF in infants is safe and effective, with satisfactory short- and medium-term outcomes. Optimizing operation m
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2017年第1期119-123,共5页
Academic Journal of Second Military Medical University
基金
国家自然科学基金(81500298)
广东省自然科学基金(2014A030310473)
广州市珠江科技新星专项(201610010094)~~
关键词
法洛四联症
婴儿
心脏外科手术
围手术期医护
随访
tetralogy of Fallot
infant
cardiac surgical procedures
perioperative care
follow-up
