大动脉调转术治疗年龄6个月以上重度肺动脉高压患者疗效分析

目的评价大动脉调转术治疗年龄6个月以上重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者的中期疗效。方法对86例年龄6个月以上的重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者行大动脉调转手术,观察术后病死率、并发症发生率、术后肺动脉压力等,分析手术死亡、术后持续性肺动脉高压的影响因素。结果本组住院死亡6例（6.98%）,72例完成随访,死亡2例;存活者心功能NYHAⅡ级2例（2.86%）,心功能NYHAⅠ级68例（97.14%）;术后肺动脉压（30.5±13.0）mm Hg明显低于术前（64.9±13.0）mm Hg,经皮血氧饱和度（99.7±0.7）%明显高于术前（72.0±15.0）%（P〈0.05）;多因素回归分析显示,术后肺动脉高压、一氧化氮吸入、血浆胶体渗透压监测是手术死亡的独立预测因子（OR=1.236,95%CI：1.080-1.415,P=0.002;OR=0.016,95%CI：0.001-0.345,P=0.008;OR=0.070,95%CI：0.006-0.829,P=0.035）,手术年龄与持续性肺动脉高压独立相关（OR=1.283,95%CI：1.073~1.536,P=0.006）。结论大动脉调转术治疗大龄重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者中期效果良好。

Therapeutic effect of arterial switch operation on severe pulmonary hypertension in children aged older than 6 months

Objective To evaluate the mid-term effect of arterial switch operation on severe pulmonary hypertension complicated with ventricular septal defect,transposition of great arteries and Taussig-Bing abnormality in children aged older than 6months.Methods Eighty-six patients aged over 6months with severe pulmonary hypertension complicated with ventricular septal defect,transposition of great arteries and Taussig-Bing abnormality undergone arterial switch operation were observed the fatality,incidence of complications and postoperative pulmonary arterial pressure to analyze the influential factors of postoperative death and persistent pulmonary hypertension.Results There were 6hospitalized deaths（6.98%）.In the follow-up survey in 72 patients,2died.In the survived patients,there were 2patients（2.86%）in NYHA Ⅱ and 68patients（97.14%）in NYHA Ⅰ.The pulmonary arterial pressure was lower after operation（（30.5±13.0）mm Hg）than that before operation（（64.9±13.0）mm Hg）,and percutaneous blood oxygen saturation was higher after operation（（99.7±0.7）%）than that before operation（（72.0±15.0）%）（P〈0.05）.Multivariable regression analysis showed the postoperative pulmonary hypertension,inhaling of nitric oxide and monitoring of plasma colloid osmotic pressure were the independent risk factors for death（OR=1.236,95%CI：1.080 to 1.415,P=0.002;OR=0.016,95%CI：0.001 to 0.345,P=0.008;OR=0.070,95%CI：0.006 to 0.829,P=0.035）.The patients age was independently correlated with persistent pulmonary hypertension（OR=1.283,95%CI：1.073 to 1.536,P=0.006）.Conclusion Arterial switch operation has a satisfactory mid-term result for patients aged older than 6months with severe pulmonary hypertension complicated with ventricular septal defect,transposition of great arteries and Taussig-Bing abnormality.