Fontan手术后并发症相关因素的分析及干预研究

上海交通大学医学院附属上海儿童医学中心心脏中心(上海市,200127)

Fontan术后; 并发症; 相关因素; 干预

Related factors and interventions for complications after Fontan operation.
Yu Hongyun,Gu Xiaorong,Guan Yongmei.

Heart Center,Affiliated Shanghai Children's Medical Center,Shanghai Jiao Tong University,Shanghai 200127,China.Corresponding author:Guan Yongmei,Email:gymscmc@163.com.

Fontan procedure; Complication; Related factors; Intervention

DOI: 10.3969/j.issn.1671— 6353.2018.09.010

备注

目的 探讨Fontan术后并发症产生的相关因素及干预方案。方法 以2014年1月至2016年1月在本院行Fontan术后出现并发症的47例患儿作为研究对象,分析并发症发生的相关因素及干预措施。结果 47例患儿中20例(内管道手术13例、外管道7例)出现心律失常伴有低心排血量综合征、7例出现低氧血症、11例出现胸腔积液、6例出现肾功能受损、2例出现肝肾功能受损、1例出现脑部并发症,2例因室颤抢救无效死亡(病死率为4.26%)。呼吸机使用时间2~160 h,胸腔引流时间4~28 d,术后监护时间3~12 d。结论 Fontan手术作为治疗复杂先天性心脏病的手术方法,已广泛应用于临床,而术后多种并发症的出现会造成患儿恢复时间延长甚至死亡,针对术后并发症产生相关因素进行分析,采取有效的预防和干预措施,能促使患儿早日康复,降低病死率。
Objective To explore the related factors and interventions for complications after Fontan operation. Methods A total of 47 children with complications after Fontan operation were analyzed retrospectively from January 2014 to January 2016.And related factors and interventions were analyzed. Results Among 20 cases of arrhythmia with low cardiac output,intracardiac(n=13)and extracardiac(n=7)conduit Fontan operations were performed.There were also hyoxemia(n=7),pleural effusion(n=11),abnormal renal function(n=6),abnormal hepatorenal function(n=2),cerebral complications(n=1)and ventricular fibrillation(n=2).The morality rate was 4.26%.The time of mechanical ventilation was 2 to 160 h,the length of pleural drainage 4 to 28 days and the duration of ICU(intensive care unit)3 to 12 days. Conclusion Fontan operation has been widely applied for complicated congenital heart disease.Postoperative complications may prolong the recovery time and even cause death.Effective preventive and interventional measures are needed.