双向Glenn手术治疗紫绀型复杂先天性心脏病

目的总结双向Glenn手术治疗紫绀型复杂先天性心脏病的临床经验。方法回顾性分析2007年1月至2012年12月新疆维吾尔自治区人民医院68例紫绀型复杂先天性心脏病行双向Glenn手术患者的临床资料,其中男40例、女28例,年龄3个月至22岁,平均年龄3.9岁;体重6.2~53.0（13.6±8.5）kg。术前诊断包括三尖瓣闭锁20例,单心室11例,右心室双出口10例,完全型大动脉转位7例,三尖瓣狭窄5例,肺动脉闭锁5例,矫正型大动脉转位4例,法洛四联症4例,三尖瓣下移畸形2例。其中合并右位心、右旋心14例,单心室并肺动脉高压行肺动脉环缩术后2例,完全型大动脉转位行中心分流术后1例。23例和45例紫绀型复杂先天性心脏病分别在体外循环和非体外循环下施行手术。结果术后早期死亡2例,1例死于严重的低心排血量综合征,1例死于肺部感染。脉搏血氧饱和度从术前的66.8%±11.8%提高至出院时的89.3%±7.4%（P〈0.05）。其中53例脉搏血氧饱和度术后较术前升高〉10%。红细胞压积由术前0.49±0.11降至术后的0.40±0.07（P〈0.05）。术后发生胸腔积液16例（23.5%）,乳糜胸7例（10.3%）,低心排血量综合征5例（7.4%）,心律失常4例（5.9%）,气胸1例（1.5%）。以上并发症均经相应的治疗治愈。随访55例,随访时间9个月至6年,所有吻合口血流通畅,无狭窄,无血栓形成,临床效果满意。4例患者分别于术后2~5年完成全腔静脉-肺动脉连接术,恢复顺利。结论双向Glenn手术安全、可靠,是一种治疗难以解剖根治或需一期生理矫治的紫绀型复杂先天性心脏病患者的较好手术术式。

Bidirectional Glenn Procedure for the Treatment of Complex Cyanotic Congenital Heart Diseases

Objective To summarize our clinical experience of bidirectional Glenn procedure （BGP） for the treatment of complex cyanotic congenital heart disease （CHD）. Methods Clinical data of 68 patients with complex cyanotic CHD who underwent BGP in People＇s General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years （range, 3 months to 22 years） and body weight of 6.2-53.0 （ 13.6 ± 8.5 ）kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle （SV） in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein＇s anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass （CPB） and 45 patients received BGP without CPB. Results Two patients died postoperatively, including 1 patient with severe low cardiac output syndrome （LCOS） and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation （SpOz, 89.3%± 7.4%） was significantly higher than preoperative SpO2 （66.8%± 11.8%,P 〈 0.05 ）. In 53 patients, postoperative SpO2 was more than 10% higher than preoperative SpO2. Postoperative hematocrit （0.40± 0.07 ） was significantly lower than preoperative hematocrit （0.49 ± 0.11, P 〈 0.05 ）. Postoperative complications included pleural effusion in 16 patients （23.5%）, chylothorax in 7 patients （10.3%）, LCOS in 5 patients （7.4%）, arrhythmias in 4 patients （5.9%）, and pneumothora