69例婴儿法洛四联症的围术期处理
李海杰1,张锋泉2,宁岩松3,王同建3,邵宝伟3,张希全1

1. 山东大学齐鲁医院心脏外科(山东省济南市,250012); 2. 济南市中心医院心脏外科(山东省济南市,250033); 3. 济南军区总医院心血管病研究所(山东省济南市,250022)

法洛氏四联症; 婴儿; 围手术期

Perioperative management of infantile Tetralogy of Fallot.
Li Haijie1, Zhang Fengquan2, Ning Yansong3, Wang Tongjian3, Shao Baowei3, Zhang Xiquan1.

1.Cardiovascular Department, Qilu Hospital of Shandong University, Jinan, shan-dong, China, 250012; 2.Cardiovascular Department of Jinan Central Hospital, Jinan, shan-dong, China, 250033; 3.Institute of Cardiovascular Disease, General Hospital of Jinan Military Region, Shan-dong Jinan 250022,China.Corresponding author:zhang Xiquan,E-mail:tottilee99@163.com

Tetralogy of Fallot; Infant; Perioperative period

DOI: 10.3969/j.issn.1671-6353.2017.03.0.16

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目的 总结69例婴儿法洛四联症一期根治术的围术期处理经验,探讨婴儿法洛四联症的围术期处理方法。 方法 2008年1月至2016年2月,我们实施婴儿法洛氏四联症一期根治术69例,均合并房间隔缺损、左上腔静脉、动脉导管未闭等一种或多种畸形。采取标准体外循环手术43例,深低温低流量体外循环手术26例。均常规应用改良超滤技术,均实施一期根治手术。 结果 69例中,死亡4例,治愈65例。死亡原因:严重低心排综合征、低氧血症、肾功能不全。全部病例呼吸机辅助时间12～89 h,平均(35.1±21.8)h。ICU滞留时间5～12 d,平均(7.3±3.9)d。术后住院时间10～26 d,平均(13.2±5.2)d。术后主要并发症包括:低心排综合征9例,低氧血症8例,肺不张14例。 结论 婴儿法洛四联症围术期应注重循环及呼吸的管理,积极防治低心排出量综合征和肾功能不全,是提高治愈率的关键。
Objective To summarize the clinical experiences of preoperative management for Tetralogy of Fallot(TOF)during one-stage radical surgery. Methods From January 2008 to February 2016,69 cases of TOF neonates with one or more malformations including atrial septal defect,left superior vena cava and patent ductus arteriosus underwent radical surgery. The procedures were standard cardiopulmonary bypass(n=43)and deep hypothermic & low-flow(n=26). One-stage radical surgery with modified ultrafiltration technology was routinely applied. Results Four deaths were due to severe low cardiac output,hypoxemia and renal insufficiency. The mean mechanical ventilation time was(35.1±21.8)(12～89)hours,mean ICU monitoring time(7.3±3.9)(5～12)days and mean postoperative hospital stay(13.2±5.2)(10～26)days. The major postoperative complications included low cardiac output(n=9),hypoxemia(n=8)and atelectasis(n=14). Conclusion s Perioperative management of neonatal TOF should focus upon circulation and respiration,prevention and treatment for postoperative low cardiac output and renal dysfunction.