非体外循环下双向格林手术的临床应用

目的总结分析非体外循环下双向格林手术的临床经验。方法2001年1月-2007年12月,本院应用非体外循环下双向格林手术治疗复杂先天性心脏病22例,其中16例建立上腔静脉右心房旁路行单侧双向格林术,6例利用双上腔静脉互为旁路行双侧双向格林术。术前经皮血氧饱和度为0.72±0.04,术中肺动脉压为14.1±2.5 mmHg。结果全组无死亡,术中腔肺转流时间34±12 min,术毕经皮血氧饱和度升高至0.89±0.03,术后肺动脉压16.1±3.2 mmHg,胸腔及心包引流液192±68 ml,呼吸机辅助时间12±5 h,ICU监护时间21±13 h,住院时间14±5 d。术后2例出现乳糜胸,无恶性心律失常、血栓形成和脑部并发症发生。结论非体外循环下双向格林术的手术方法安全,并发症少,建立足够大的腔静脉和肺动脉吻合口、围术期的正确处理是提高近、远期疗效的关键所在。

Clinical application of bidirectional Glenn shunt with off-pump technique

Objective To review the clinical experience of bidirectional Glenn shunt with off-pump technique. Methods From January 2001 to December 2007, 22 patiehts with complex congenital disease underwent off-pump bidirectional Glenn shunt ： unilateral bidirectional Glenn shunt in 16 cases and bilateral bidirectional Glenn shunt in 6 cases. SpO2 was 0.72 ± 0.04 befnre operation, and pulmonary pressure was 14. 1 ± 2. 5 mmHg during operation. Results No hospitalized mnrtality, occurred in all cases. The mean SVC crossclamp time was 34 ± 12 min during operation. The postoperative SpO2 and puhnonary pressure were 0.89 ±0.03 and 16. 1 ± 3.2 mmHg respectively. The postoperative drainage of thoracic cavity anti perlcardial cavity was 192 ±68 ml. The average mechanical ventilation time was 12 ± 5 h. The monitoring time in ICU was 21 ± 13 h. The mean postoperative hospital stay was 14 ± 5 d. Except two cases were complicated with chylethorax postoperatively, there were no complications like severe arrhythmia, thrombosis and cerebral problems. Conclusion Bidirectional Glenn shunt with off-pnmp is a safe and effective technique with few complications, and clinical outcomes are satisfactory. The key points for the successful operation are establishment of big enough cava-pulmonary anastomosis as well as aggressive oeriooerative management.