新生儿室间隔完整型大动脉转位的外科治疗时机及预后
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摘要
目的分析大动脉调转术(artery switch operation,ASO)治疗新生儿室间隔完整型大动脉转位(transposition of the great arteries with intact ventricular septum,TGA/IVS)的手术时机和预后。方法回顾性分析2012年2月至2015年2月,在陆军总医院附属八一儿童医院接受ASO治疗的25例新生儿病历资料,急诊手术组13例,限期手术组12例,比较2组儿的手术预后。结果 25例患儿中,男19例,女6例。急诊手术组与限期手术组的性别比例、早产儿比例、出生体重、入院时日龄、手术时体重、手术时日龄、大动脉位置关系等指标比较,差异均无统计学意义(P值均>0.05)。急诊手术组入院至手术时间短于限期手术组[1.0(1.0~1.5)与9.5(8.3~14.8)天,T=91.000,P<0.05]。急诊手术组患儿术前机械通气的比例高于限期手术组(13/13与3/12,χ~2=15.234,P<0.05),术前氧分压低于限期手术组[23(17~27)与30(23~45)mm Hg,T=127.000,P<0.05]。2组术中体外循环时间、主动脉阻断时间、延迟关胸比例比较,差异均无统计学意义(P值均>0.05)。急诊手术组与限期手术组术后早期出现低心排综合征的比例(2/13与1/12,χ~2=0.294)、术后早期死亡的比例(1/13与1/12,χ~2=0.003)、以及总住院时间[26.0(18.5~27.5)与33.5(21.5~40.8)天,T=150.500]比较,差异均无统计学意义(P值均>0.05)。结论急诊ASO手术治疗新生儿TGA/IVS,采用合理的围术期处理,可取得较好的近、远期效果。
Objective To analyze the surgical timing and outcome of artery switch operation(ASO) for neonates with transposition of the great arteries with intact ventricular septum(TGA/IVS). Methods 25 patients underwent ASO from February 2012 to February 2015 were analyzed retrospectively. There were 13 cases in group of emergency operation(group A), and 12 cases in group of selective operation(group B). The surgical outcomes of two groups were compared. Results There were 19 male cases and 6 female cases among the 25 patients. The indexes of sex ratio, proportion of premature infants, birth weight, age at hospitalization, weight at operation, age at operation and artery location of the two groups were no statistically different(P>0.05). The duration of admission to operation of group A was shorter than that of group B[1.0(1.0~1.5) vs 1.0(8.3~14.8) d, T=91.000, P<0.05)]. The ratio of pre-operation mechanical ventilation of group A was higher(13/13 vs 3/12, χ~2=15.234, P < 0.05), while pre-operative oxygen partial pressure was lower than that of group B[23(17~27) vs 30(23~45) mm Hg, T=127.000, P<0.05)]. Therewere no statistically difference(P>0.05) in extracorporeal circulation time, aorta blocking time and the ratio of delayed sternal closure. Meanwhile, the proportion of early low cardiac output syndrome(2/13 vs 1/12, χ~2=0.294), the proportion of early post-operative death(1/13 vs 1/12, χ~2 = 0.003), and the duration of hospital stay [26.0(18.5~27.5) vs 18.5(21.5~40.8) d, T=150.500] of the two groups were no statistically different(P>0.05). Conclusion Reasonable perioperative management in neonates with TGA/IVS can obtain better short-and long-term efficacy.
Objective To analyze the surgical timing and outcome of artery switch operation(ASO) for neonates with transposition of the great arteries with intact ventricular septum(TGA/IVS). Methods 25 patients underwent ASO from February 2012 to February 2015 were analyzed retrospectively. There were 13 cases in group of emergency operation(group A), and 12 cases in group of selective operation(group B). The surgical outcomes of two groups were compared. Results There were 19 male cases and 6 female cases among the 25 patients. The indexes of sex ratio, proportion of premature infants, birth weight, age at hospitalization, weight at operation, age at operation and artery location of the two groups were no statistically different(P>0.05). The duration of admission to operation of group A was shorter than that of group B[1.0(1.0~1.5) vs 1.0(8.3~14.8) d, T=91.000, P<0.05)]. The ratio of pre-operation mechanical ventilation of group A was higher(13/13 vs 3/12, χ~2=15.234, P < 0.05), while pre-operative oxygen partial pressure was lower than that of group B[23(17~27) vs 30(23~45) mm Hg, T=127.000, P<0.05)]. Therewere no statistically difference(P>0.05) in extracorporeal circulation time, aorta blocking time and the ratio of delayed sternal closure. Meanwhile, the proportion of early low cardiac output syndrome(2/13 vs 1/12, χ~2=0.294), the proportion of early post-operative death(1/13 vs 1/12, χ~2 = 0.003), and the duration of hospital stay [26.0(18.5~27.5) vs 18.5(21.5~40.8) d, T=150.500] of the two groups were no statistically different(P>0.05). Conclusion Reasonable perioperative management in neonates with TGA/IVS can obtain better short-and long-term efficacy.
引文
[1]董念国,孙宗全,苏伟,等.一期大动脉调转术治疗完全性大动脉转位[J].临床心血管病杂志,2009,25(2):122-124.
[2]Roussin R,Belli E,Bruniaux J,et al.Surgery for transposition of the great arteries in neonates weighing less than 2,000 grams:a consecutive series of 25 patients[J].Ann thorac surg,2007,83(1):173-178.
[3]Pretre R,Tamisier D,Bonhoeffer P,et al.Results of the arterial switch operation in neonates with transposed great arteries[J].Lancet,2001,357(9271):1826-1830.
[4]Kang N,de Leval MR,Elliott M,et al.Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum[J].Circulation,2004,110(11):123-127.
[5]徐志伟,丁文祥,苏肇伉.室间隔完整型大动脉错位的手术治疗[J].中华外科杂志,2002,40(8):574-576.
[6]孙新,何少茹,庄建,等.大动脉调转术手术时机对完全性大动脉转位患儿预后的影响[J].实用儿科临床杂志,2011,26(13):1045-1048.
[7]Van Praagh R,Jung WK.The arterial switch operation in transposition of the great arteries:anatomic indications and contraindications[J].Thorac Cardiovasc Surg,1991,39(2):138-150.
[8]Qamar ZA,Goldberg CS,Devaney EJ,et al.Current risk factors and outcomes for the arterial switch operation[J].Ann Thorac Sury,2007,84(3):871-878.
[9]Hashemzadeh K,Hashemzadeh S.In-hospital outcomes of delayed stemal closure following pediatric surgery[J].J Card Sury,2009,24(1):30-33.
[10]晏馥霞,王宇红,王嵘,等.完全性大动脉转位矫治手术的围术期处理[J].实用儿科临床杂志,2009,24(12):951-953.
[11]钟敏泉,曽小璐,郭予雄,等.影响大动脉调转术治疗完全型大动脉转位患儿死亡的危险因素[J].实用儿科临床杂志,2011,26(7):545-547.
[12]Kutty S,Zahn EM.Interventional therapy for neonates with critical congenital heart disease[J].Catheter Cardiovasc Interv,2008,72(5):663-674.
[2]Roussin R,Belli E,Bruniaux J,et al.Surgery for transposition of the great arteries in neonates weighing less than 2,000 grams:a consecutive series of 25 patients[J].Ann thorac surg,2007,83(1):173-178.
[3]Pretre R,Tamisier D,Bonhoeffer P,et al.Results of the arterial switch operation in neonates with transposed great arteries[J].Lancet,2001,357(9271):1826-1830.
[4]Kang N,de Leval MR,Elliott M,et al.Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum[J].Circulation,2004,110(11):123-127.
[5]徐志伟,丁文祥,苏肇伉.室间隔完整型大动脉错位的手术治疗[J].中华外科杂志,2002,40(8):574-576.
[6]孙新,何少茹,庄建,等.大动脉调转术手术时机对完全性大动脉转位患儿预后的影响[J].实用儿科临床杂志,2011,26(13):1045-1048.
[7]Van Praagh R,Jung WK.The arterial switch operation in transposition of the great arteries:anatomic indications and contraindications[J].Thorac Cardiovasc Surg,1991,39(2):138-150.
[8]Qamar ZA,Goldberg CS,Devaney EJ,et al.Current risk factors and outcomes for the arterial switch operation[J].Ann Thorac Sury,2007,84(3):871-878.
[9]Hashemzadeh K,Hashemzadeh S.In-hospital outcomes of delayed stemal closure following pediatric surgery[J].J Card Sury,2009,24(1):30-33.
[10]晏馥霞,王宇红,王嵘,等.完全性大动脉转位矫治手术的围术期处理[J].实用儿科临床杂志,2009,24(12):951-953.
[11]钟敏泉,曽小璐,郭予雄,等.影响大动脉调转术治疗完全型大动脉转位患儿死亡的危险因素[J].实用儿科临床杂志,2011,26(7):545-547.
[12]Kutty S,Zahn EM.Interventional therapy for neonates with critical congenital heart disease[J].Catheter Cardiovasc Interv,2008,72(5):663-674.
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