先天性矫正大动脉转位解剖矫治手术后早期并发症处理.docVIP

先天性矫正大动脉转位解剖矫治手术后早期并发症的处理 　　作者：韩宏光,汪曾炜,张南滨,朱洪玉　　作者单位：沈阳军区总医院心血管外科，辽宁 沈阳 　　【摘要】目的：回顾性分析先天性矫正大动脉转位 (cTGA )解剖矫治手术后的早期并发症及处理经验。方法： 2002年4月至2007年10月我科行双调转手术治疗cTGA 合并心内畸形患儿15例。全组均在全麻中度低温、低流量体外循环下行心内直视解剖矫治手术。手术方式包括改良Senning + Rastelli 13例,Mustard + Rastelli+双向Glenn 术1例、改良Senning+Switch 术1 例。结果：术后早期死亡3例(20%),死亡原因为低心排出综合征和左心功能衰竭。术后低心排出量综合征1例,交界性心律或伴室性早搏二联律6例;交界性心律伴Ⅲ度房室传导阻滞及阵发性室速1例;室上性心动过速1例;Ⅲ度房室传导阻滞1例，右上肺不张1例，引流管留置时间10 d 2例，胸腔积液1例。结论： 加强矫正大动脉转位解剖矫治术后监护及综合治疗措施，及时纠正术后低心输出量综合征，积极防治术后心律失常等均为提高手术成功率的关键因素。早期行双调转手术可解剖矫治cTGA 合并心内畸形,死亡率低,中、远期心功能效果好。 　　【关键词】 心脏缺损,先天性,心脏外科手术,手术后并发症 　　Abstract：Objective:To retrospectively analyze the experience of early postoperative complications and their management after double switch operation　　for congenital corrected transposition of great arteries (cTGA) with heart anomaly.　Methods: From April 2002 to October 2007, 15 children patients with cTGA underwent double switch operation.After general anesthesia, all the patients were operated under mid-hypothermia circulator arrest and low-flow perfusion. The operative methods comprised 13 cases of modified Senning+Rastelli, one case Mustard+Rastelli+bidirectional Glenn, and one case modified Senning+Switch.Resuits：There were three cases early postoperative deaths in 15 cases(20%). The reasons for the deaths were left ventricular failure and low cardiac output syndrome. The postoperative complications included severe low cardiac output syndrome in one, junctional rhythm or with ventricular premature beat bigeminy in six, junctional rhythm with third-degree atrioventricular block and paroxism ventricular tachycardia in one, supraventricular tachycardia in one, third-degree atrioventricular block in one, right upper lung atelectasis in one, drainage tube indwelling time10d in two, hydrothorax in one case.Conclusion:Strict，intensive surveillance and promptly synthesized treatment for low cardiac output syndrome，cardiac arrhythmia can improve the operative results. Early therapy may effectively a