摘要
目的探讨外科治疗婴幼儿重症左冠状动脉起源于肺动脉(ALCAPA)的结果和术后恢复的影响因素。方法回顾上海儿童医学中心2003年1月至2018年1月的ALCAPA病例,根据手术时间分为前期手术组(2003年1月至2012年12月)及后期手术组(2013年1月至2018年1月),两组又分为重症组[术前左心室射血分数(LVEF)≥0.35)和对照组(LVEFM0.35),分析比较两个不同时间段各组间临床数据。结果本次研究总计纳入102例病例,根据手术时间及术前LVEF分组:前期重症组10例,院内死亡4例(40%);前期对照组28例,院内死亡3例(10.7%)。前期两组之间在术前LVEF(0.29±0.06对0.53±0.12)、手术年龄[(8.0±7.9)个月对(23.3±27.7)个月]及体外循环[(131.1±39.6)min对(103.8±29.8)min]差异均有统计学意义。后期手术重症组24例,院内死亡4例(16.7%);对照组40例,陨内死亡2例(5%)。后期两组术前LVEF(0.28±0.05对0.59±0.12)、左心室舒张末内径(LVDD)-Z值(3.09±I.16对2.11±0.95)、手术时年龄[(5.3±3.0)个月对(24.8±30.5)个月]和主动脉阻断[(67.1±15.5)min对(82.7±28.4)min]差异均有统计学意义。重症组前、后期对比,患儿术前临床指标差异无统计学意义,院内死亡从前期的40.0%下降至后期的10.7%.13例(38.2%)重症ALCAPA患儿进行机械辅助支持(MCS),辅助期间1例死亡,2例撤机后死亡。结论重症ALCAPA的手术院内死亡比例较高,可能与患儿术前严重心脏缺血、心脏扩大、手术年龄小有关。外科手术的进步及临床早期合理使用MCS技术进行辅助,可提高院内生存率。
Objective To discuss the surgical treatment of anomalous origin of the left coronan1 artery from the pulmonary artery ( ALCAPA) and the risk factors of postoperative recovery in infants and children. Methods A retrospective review of all patients who underwent surgical treatment of ALCAPA in Shanghai Children Medical Center(2003. 1 -2018. 1 ) was conducted. Patients were divided into early surgery group(2003. 1 -2012. 12) and late surgery group(2013. 1 -2018. 1 ) according to the operation time, a preoperative left ventricular ejection fraction( LVEF)<0. 35 was defined as severe group and LVEFM 0. 35 as the control group in both surgery group. Meantime, and the clinical data among the groups were analyzed and compared .Results 102 patients were included in our study. According to the operation time and preoperalive LVEF grouping: 10 cases in the early severe group, early death in 4 cases(40%);28 cases in the early control group, ard 3 cases died( 10. 7%) in hospital. Preoperative LVEF(0. 29 ± 0. 06 vs. 0. 53 ± 0. 12 ), surgical age [(8.0 ±7.9) months vs.( 23. 3 ± 27. 7 ) months], and cardiopulmonary bypass time [(131. 1 ± 39. 6 ) min vs.( 103. 8 ± 29. 8 ) min ] were statistically different between lhe early two groups. The results of the late surgery had been improved : 24 cases in the late severe group, 4 cases died in hospital(16.7%);40 cases in lhe late control group, and early death in 2 cases( 5%). In lhe late surgery groups, there was a statistically significant difference in preoperative LVEF(0. 28 ±0. 05 vs. 0. 59 ±0. 12), left ventricular end-diastolic diameter( LVDD) Z- score (3. 09 ± 1. 16 vs. 2.11 ± 0. 95 ), and surgical age [(5.3 ±3.0) months vs.( 24. 8 ± 30. 5 ) months], clamping time [(67. 1 ±15.5) min vs.(82. 7 ± 28. 4 ) min]. In the severe group, there was no significant difference in preoperative clinical data between early and late patients, and the early mortality decreased frem 40% in the early period to 16.7% in the late period. In this study, 13 cases(38. 2%) of children with
作者
郑景浩
张蔚
何晓敏
刘玉洁
杨寅愉
Zheng Jinghao;Zhang Wei;He Xiaomin;Liu Yujie;Yang Yinyu(Department of Cardiolhoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127、China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2019年第3期140-144,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
左冠状动脉起源肺动脉
射血分数
二尖瓣反流
机械辅助循环
Anomalous origin of the left coronary artery from the pulmonary artery
Ejection fraction
Mitral re-gurgitation
Mechanical circulation support
