摘要
目的评价小左心室对新生儿完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)术后早期治疗效果的影响。方法收集2012年1月至2016年1月收治并行手术治疗的新生儿期TAPVC患儿37例,排除合并单心室、心房异构等严重畸形患儿,所有患儿均行双心室根治术。按照左心室舒张末期容积指数(lef tventricular end-diastolic volume index,LVEDVI),将LVEDVI<20ml/m^2的患儿定义为小左心室组(S组,14例),将LVEDVI≥20ml/m^2的患儿定义为接近正常左心室组(N组,23例)。所有患儿均合并房间隔缺损或卵圆孔未闭;解剖分型按Darling分型:心上型16例,心下型9例,心内型12例。收集患儿手术日龄、体重、性别、分型、体外循环时间、主动脉阻断时间、术前肺静脉是否梗阻、术前LVEDVI、房间隔缺损大小等指标。采用χ2检验、t检验、二分类Logistic回归分析对术中情况、术后并发症情况及死亡危险因素进行分析。结果术后共死亡6例,S组及N组各3例。两组主动脉阻断时间、体外循环时间、术后机械通气时间、术前呼吸机辅助、术后病死率等比较,差异均无统计学意义(P>0.05)。术后S组正性肌力药物评分为(21.3±4.1)分,N组为(18.3±4.0)分,组间比较,差异有统计学意义(P=0.037)。S组术后出现心律失常10例(71.4%),N组为8例(34.5%),组间比较,差异有统计学意义(P=0.031)。两组低心排出量、肺动脉高压危险、是否行透析、吻合口狭窄、肺部感染等并发症的发生率比较,差异均无统计学意义(P>0.05)。单因素及多因素分析结果显示TAPVC术后早期死亡的危险因素为术前机械通气、体外循环时间、年龄和体重,其中年龄、体外循环时间为其独立危险因素。结论小左心室并不增加术后病死率,但术后更易出现低心排出量及心律失常。年龄、体外循环时间为影响术后死亡的独立危险因素。
Objective To explore the impacts of left heart function for neonates with total anomalous pulmonary venous connection (TAPVC) on early outcomes of anatomical correction. Methods A retrospective analysis was performed for 37 hospitalized TAPVC neonates from January 2012 to June 2016.All cases underwent biventricular correction.And single ventricle, atrial isomerism and other complex congenital heart diseases were excluded.Based upon the index of left ventricular end-diastolic volume, LVEDVI<20 ml/m^2 was classified as small LV while LVEDVI≥20 ml/m^2 approximated normal LV.According to the Darling’s scheme, the types were supracardiac (n=16), infracardiac (n=9) and intracardiac (n=12). Various factors including age, body weight, pathological type, LVEDVI, pulmonary venous obstruction and restricted atrial septal defect were compared. Results There were 6 operative deaths (n=3 in each group). No significant inter-group differences existed in operative deaths, cardiopulmonary bypass time, aortic-cross clamping time or mechanical ventilation.While the doses of positive inotropics in group N were shorter than those in group S [(21.3±4.1)vs.(18.3±4.0)points](P=0.037). No significant inter-group difference existed in low cardiac output syndrome, pulmonary hypertension, peritoneal dialysis, postoperative anastomotic or pulmonary vein stenosis or pneumonia.And mechanical ventilation, age, cardiopulmonary bypass time and weight were the risk factors of mortality while the independent risk factors included age and cardiopulmonary bypass time. Conclusions Small LV does not increase the mortality.However, arrhythmia and low cardiac output syndrome are more likely to occur.And age and cardiopulmonary bypass time are the independent risk factors.
作者
习林云
吴春
潘征夏
李勇刚
项明
Xi Linyun;Wu Chun;Pan Zhengxia;Li Yonggang;Xiang Ming(Department of Cardiothoracic Surgery, Affiliated Children’s Hospital, Chongqing Medical University,Ministry of Education Key Laboratory of Child Development & Disorder,Ministry of Education Key Laboratory of Child Development & Disorder,Key laboratory of Pediatrics in Chongqing ,Chongqing International Science & Technology Cooperation Center for Child Development & Disorders,Chongqing 400014 ,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第3期203-207,共5页
Chinese Journal of Pediatric Surgery
基金
国家临床重点专科建设项目(国卫办医函[2013]544)。
关键词
全肺静脉异位引流
新生儿
危险因素
Total anomalous pulmonary venous drainage
Newborn
Risk factor
