婴幼儿主动脉缩窄一期手术治疗28例临床总结

【摘要】 目的探讨婴幼儿主动脉缩窄一期手术的外科治疗经验。方法 28例患儿其中22例在全麻低温体外循环选择性脑灌注下行手术治疗,采用胸部正中切口;6例单存主动脉弓缩窄则采用左后外侧切口非体外循环下行手术治疗。手术前均穿刺并术中术后监测上下肢血压,22例(78.6%)合并室间隔缺损和其他心内畸形:6例(21.4%)为单存主动脉弓缩窄;10例(35.7%)伴有严重主动脉弓发育不良,导管前型20例(71.4%),导管后型5例(17.8%),局部狭窄3例(10.7%)。采用缩窄段切除及对端吻合16例,缩窄段切除加扩大的端端吻合(Resection with extended end-to-end anastomosis)10例,局部补片2例。术后呼吸机辅助呼吸大于3 d,给予前列腺素E1降肺动脉高压。结果 28例手术顺利,术后下肢血压升高压差均小于20 mm Hg。1例合并肺炎并呼吸功能不全,花费高,家长放弃治疗,1例心功能不全死亡,3例术后高血压口服卡托普利处理,死亡率7.14%。结论掌握手术适应症,采用恰当手术方式,减少术后残余缩窄,是手术成功的关键。更多还原

【Abstract】 Objective to explore the infants and young children the experience of surgical treatment of aorta issue of surgery. Methods 28 cases of which 22 cases in extracorporeal circulation in low temperature selective cerebral perfusion during anesthesia downlink surgery, using the center of the chest incision. 6 cases of single deposit aortic arch narrow in left posterolateral incision under extracorporeal circulation operation. Preoperative biopsy and postoperative monitoring intraoperative onset of blood pressure, 22 cases(78.6%) of ventricular septal defect and other heart malformations: 6 cases(21.4%) for single aortic arch narrowed; 10 cases(35.7%) with severe aortic arch hypoplasia, catheter type before 20 cases(71.4%), after catheter type 5 cases(17.8%), local stenosis in 3 patients(10.7%). Using narrow segment Resection and to end anastomosis in 16 cases, expanding narrowed segment Resection with end to end anastomosis(Resection with extended end- to- end anastomosis) 10 cases, local patch in 2 cases. Postoperative respiratory machine help to breathe more than 3 days, giving prostaglandin E1 down pulmonary hypertension. Results 28 cases operation smoothly, postoperative lower limb blood pressure rises high pressure difference are less than 20 MMHG. 1 case with pneumonia and respiratory insufficiency, cost is high, the parents to give up treatment, 1 case of cardiac insufficiency died, 3 cases of postoperative hypertension oral captopril treatment, mortality is 7.14%. Conclusion master the operation indications, adopt proper surgery way, reduce the postoperative residual narrow, is the key to successful operation.更多还原