双动脉根部调转术治疗大动脉转位合并室间隔缺损和左心室流出道狭窄术后早期临床结果分析

目的:对双动脉根部调转(DRT)术后临床资料进行分析,总结术后早期恢复特点及治疗方法.方法:回顾性分析2004-11至2011-05我院72例患儿实施DRT术术后早期临床资料.结果:全组年龄4月~6岁,平均年龄(2.85±2.02)岁,体重5.5~20 kg,平均体重(11.61±3.88)kg.术后呼吸机辅助时间(160±168)h,术后重症监护病房住院时间(10±11)d.特殊治疗包括:延迟关胸9例(12.5%),7例(9.7%)同时行体外膜肺氧合(ECMO)辅助,腹膜透析17例(23.6%),应用心外膜临时起搏器46例(63.9%),二次手术4例(5.6%),二次气管插管5例(6.9%).因顽固性心功能不伞和多器官功能衰竭死亡2例(2.8%).结论:DRT手术治疗合并左心室流出道狭窄的大动脉转位,术后早期病情偏重.经积极正确的围术期综合治疗,可获得较好的临床结果.

The Early Clinical Outcomes for Correcting Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction by Double Roots Translocation

Objective:To study the early postoperative management of double roots translocation(DRT)for treating the transposition of the great arteries with left ventricular outflow tract obstruction. Methods:We retrospectively analyzed the medical records of 72 pediatric patients who received DRT procedure from November 2004 to May 2011 in our hospital.The patients were between 4 months to 6 years,the mean age was(2.85±2.02)years,their body weights were between(5.5～20)kg,the mean weight was(11.61±3.88)kg.We summarized the early postoperative clinical outcomes for those patients. Results:The average mechanical ventilation time was(160±168)hours and the mean ICU time was(10±11)days after the procedure.The special treatment included delayed sternal closure in 9(12.5%)cases,ECMO support in 7(9.7%)cases,peritoneal dialysis in 17(23.6%)cases,using temporary pacemaker in 46(63.9%)cases,re-operation in 4(5.6%)cases and re-intubation in 5(6.9%)cases.2(2.8%)patients died with multi-organ dysfunction. Conclusion:The patients of transposition of the great arteries with left ventricular outflow tract obstruction usually have severe clinical condition at the early postoperative stage of DRT.While with active and correct peri-operative management,we could acguire good clinical outcomes.