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  • 雷勇,聂永梅,杨齐,邓明彬*.体质量≤5 kg先天性心脏病合并肺动脉高压患儿的手术疗效[J].第二军医大学学报,2020,41(1):94-98    [点击复制]
  • LEI Yong,NIE Yong-mei,YANG Qi,DENG Ming-bin*.Surgical treatment for congenital heart disease combined with pulmonary artery hypertension in children with body weight ≤ 5 kg[J].Acad J Sec Mil Med Univ,2020,41(1):94-98   [点击复制]
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体质量≤5 kg先天性心脏病合并肺动脉高压患儿的手术疗效
雷勇,聂永梅,杨齐,邓明彬*
0
(西南医科大学附属医院心胸外科(心脏大血管外科), 泸州 646000
*通信作者)
摘要:
目的 评价体质量≤ 5 kg先天性心脏病合并肺动脉高压(CHD-PAH)患儿的手术疗效。方法 回顾性收集2016年8月至2018年8月在西南医科大学附属医院接受手术治疗的29例体质量≤ 5 kg的CHD-PAH患儿的临床资料,分析其手术并发症和死亡原因。对术后存活的26例患儿术前、出院前、术后第6个月的肺动脉压(PAP)、主肺动脉与升主动脉内径比值(MPA/AAO)、心室射血前期时间和肺动脉血流加速时间比值(PEP/AT)、动脉血氧分压(PaO2)、指脉氧饱和度(SpO2)、患儿身高与正常儿童身高比、患儿体质量与正常儿童体质量比和儿童肺动脉高压功能分级进行分析,评估术后疗效。结果 29例患儿均顺利完成手术,术后并发症包括低心排出量综合征(2例)、肺动脉高压危象(1例)、残余分流或术后导管再通(2例)、心律失常(1例)、肝功能不全(1例)、切口延迟愈合(2例)。死亡3例(10.3%),其中2例死于低心排出量综合征,1例死于肺动脉高压危象。存活的26例患儿出院前和术后6个月时PAP、MPA/AAO、PEP/AT、PaO2、SpO2、患儿身高与正常儿童身高比、患儿体质量与正常儿童体质量比和儿童肺动脉高压功能分级均较术前明显改善(P<0.05)。术后6个月时,24例患儿生长发育达到同龄儿童正常水平。结论 外科手术治疗体质量≤ 5 kg的CHD-PAH患儿安全有效,能使患儿恢复正常生长发育。
关键词:  先天性心脏病  肺动脉高压  手术疗效  婴儿
DOI:10.16781/j.0258-879x.2020.01.0094
投稿时间:2019-04-14修订日期:2019-08-28
基金项目:四川省科学技术厅应用基础研究计划(14JC0191).
Surgical treatment for congenital heart disease combined with pulmonary artery hypertension in children with body weight ≤ 5 kg
LEI Yong,NIE Yong-mei,YANG Qi,DENG Ming-bin*
(Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
*Corresponding author)
Abstract:
Objective To evaluate the surgical treatment for congenital heart disease plus pulmonary artery hypertension (CHD-PAH) in children weighing less than 5 kg. Methods The clinical data of 29 CHD-PAH children with body weight ≤ 5 kg who were treated surgically between Aug. 2016 and Aug. 2018 were collected and retrospectively analyzed. Surgical complications and death causes were analyzed. Pulmonary artery pressure (PAP), the ratio of main pulmonary artery to ascending aorta diameter (MPA/AAO), the ratio of ventricular pre-ejection period to acceleration time (PEP/AT), arterial oxygen partial pressure (PaO2), pulse oxygen saturation (SpO2), the ratio of height to normal children, the ratio of weight to normal children, and functional classification of pulmonary arterial hypertension were evaluated in 26 survival children before surgery, before discharge and at 6 months after surgery. Results The procedures were finished successfully in all the 29 children. Postoperative complications were as follows:low cardiac output syndrome (LCOS, 2 cases), pulmonary hypertension crisis (1 case), residual shunt or recanalization (2 cases), arrhythmia (1 case), hepatic insufficiency (1 case), and delayed wound healing (2 cases). Three children (10.3%) died; of them 2 died of LCOS and one died of pulmonary hypertensive crisis. The above-mentioned indexes were significantly improved before discharge and at 6 months after surgery (P<0.05). The growth and development of 24 children reached the normal level 6 months after surgery. Conclusion Surgical treatment is safe and effective for CHD-PAH children with body weight ≤ 5 kg, which can restore normal growth and development of the children.
Key words:  congenital heart disease  pulmonary artery hypertension  surgical treatment  infant