全腔静脉-肺动脉连接术早期临床结果

目的总结近期全腔静脉-肺动脉连接术早期临床结果,分析影响术后早期恢复的危险因素。方法回顾分析北京阜外心血管病医院2009年2月至2010年8月行全腔静脉-肺动脉连接术58例患者的临床资料。全部患者通过超声心动图和心血管造影检查,术前临床诊断单心室26例,三尖瓣闭锁10例,肺动脉闭锁4例,右心室双出口5例,大动脉转位1例,矫正型大动脉转位12例。1例行心内隧道手术,57例行心外管道全腔静脉-肺动脉连接术。按照术后胸腔积液引流量和引流时间将患者分为两组:大量胸腔积液组,17例,其中男10例,女7例;年龄(8.61±6.73)岁;少量胸腔积液组,41例,其中男15例,女26例;年龄(7.21±4.24)岁。分析影响两组患者早期临床结果的危险因素。结果两组患者住院期间均无死亡。术后平均住院时间(12.30±9.80)d。大量胸腔积液组平均引流时间[(18.00±5.50)d vs.(5.00±2.20)d,t=-1.967,P0.05]、胸腔引流量[(12.30±2.60)ml/(kg.d)vs.(2.80±1.70)ml/(kg.d),t=-3.221,P0.05]和住院时间[(20.10±7.20)d vs.(7.20±1.10)d,t=-2.003,P0.05]明显长于或大于少量胸腔积液组,且差异有统计学意义。单因素分析显示大量胸腔积液组术前心导管测量肺动脉压明显高于少量胸腔积液组,且差异有统计学意义[(17.42±5.34)mm Hg vs.(13.91±5.22)mm Hg,t=-2.073,P0.05]。结论全腔静脉-肺动脉连接术的近期效果很好,术前肺动脉压影响术后胸腔积液量,从而影响术后恢复进程。

Early Clinical Result of Total Cavopulmonary Connection

Objective To summarize early clinical result of total cavopulmonary connection,and analyze the risk factors contributing to prolonged postoperative recovery.Methods Between February 2009 and August 2010,58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital.All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle,10 patients with tricuspid atresia,4 patients with pulmonary artery atresia,5 patients with double outlet right ventricle,1 patient with transposition of great arteries,and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection,and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel.According to their postoperative pleural drainage volume and duration,these 58 patients were divided into a large pleural drainage volume group(17 patients with 10 males and 7 females,mean age of 8.61±6.73 years)that included patients with large volume and long duration of pleural drainage,and a little pleural drainage volume group(41 patients with 15 males and 26 females,mean age of 7.21±4.24 years).A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups.Results There was no death in hospital period.The average length of hospital stay was 12.30±9.80 d.Average drainage time(18.00±5.50 d versus 5.00±2.20 d,t=-1.967,P < 0.05),drainage volume(12.30±2.60 ml/(kg.d) versus 2.80±1.70 ml/(kg.d),t=-3.221,P < 0.05),and hospital stay(20.10±7.20 d versus 7.20±1.10 d,t=-2.003,P < 0.05) of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group.Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group(17.42±5.34 mm Hg versus 13.91±5.22 mm Hg,t=-2.073,P < 0.05).Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era.Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.