摘要
目的总结复杂成人先天性心脏病(先心病)中心外管道全腔静脉肺动脉连接术(total cavopulmonary connection,TCPC)的早期临床结果,探讨影响术后ICU延迟恢复的危险因素。方法回顾性分析2012年1月到2014年12月阜外医院共20例复杂成人先心病患者行心外管道TCPC术的临床资料。其中男6例、女14例,年龄16~33(20.45±4.33)岁。结果全组住院期间无死亡,术后住ICU时间(4.4±1.7)d,住院时间(32.5±21.6)d。所有患者术后ICU内均应用多巴胺及钙剂,18例应用肾上腺素,11例应用米力农。并发症包括胸腔引流时间≥7 d者12例(60.0%),术后新发心律失常3例(15.0%),因出血再次手术3例(15.0%),切口愈合不良1例(5.0%)。单因素分析发现术前心律失常(P=0.02)、体外循环时间长于120 min(P=0.04)、术后血浆应用大于2 000 ml(P=0.01)、未开窗(P=0.04)、胸腔引流时间≥7 d(P=0.04)是ICU延迟恢复的危险因素。结论复杂成人先心病行心外管道TCPC近期效果良好,ICU早期积极使用血管活性药物维持循环利于提高患者恢复效果。
Objective To summerize the early results of total cavopulmonary connection(TCPC) procedure with an extracardiac conduit in adults with congenital heart disease,and assess risk factors for postoperative delayed recovery in ICU.Methods We retrospectively analyzed the clinical data of 20 adult patients underwent TCPC operation with extracardiac conduit in Fu Wai Hospital between January 2012 and December 2014.There were 14 female and 6 male patients at age of 16 to 33(20.45±4.33) years.Results There was no hospital mortality.The time of ICU stay was 4.4±1.7 days.And time of hospital stay was 32.5±21.6 days.Morbidities included prolonged pleural effusion lasting more than 7 days in 12 patients(60.0%),new arrhythmias in 3 patients(15.0%),reexploration for bleeding in 3 patients(15.0%),surgical wound poor healing in 1 patient(5.0%).Dopamine and calcium were used in all the patients in the ICU,epinephrine in 18 patients,milrinone in 11 patients.Risk factors for postoperative delayed recovery in ICU were preoperative arrhythmias(P=0.02),cardiopulmonary bypass time longer than 120 min(P=0.04),plasma applications more than 2 000 ml(P=0.01),absence of fenestration(P=0.04),and pleural effusion lasting longer than 7 days(P=0.04).Conclusion The TCPC procedure with an extracardiac conduit can be performed in adults with encouraged early results.Actively vasoactive drugs to maintain circulation early in ICU has good results for the patient's recovery.
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2015年第9期816-820,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金(81400305)
北京市自然科学基金(7142137)
中央级公益性科研院所基本科研业务费资助项目(2012F-014)~~
关键词
全腔静脉肺动脉连接术
心外管道
先天性心脏病
成人
Total cavopulmonary connection
Extracardiac conduit
Congenital heart disease
Adult
