大动脉调转术治疗先天性完全性大动脉转位的结果分析

发布时间：2018-02-27 15:20

  本文关键词： 完全性大动脉转位 大动脉调转术 新主动脉瓣反流 完全性大动脉转位 肺动脉高压 大动脉调转术 新主动脉瓣反流　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析完全性大动脉转位(transposition of the great arteries,TGA)的患者在动脉调转术(arterial switch operation,ASO)后出现新主动脉瓣反流(neoaortic regurgitation,NAR)的危险因素。方法:从2008年1月到2013年1月,回顾性纳入接受ASO治疗的229例TGA患者的临床资料,并对患者进行跟踪随访,重点关注ASO术后患者NAR的情况。229例患者基本情况为男173例,女56例,年龄范围3天(d)到93.9月(m),平均年龄7.8 ± 15.9 m,中位年龄1.5m,体质量范围2.4到18千克(kg),平均体质量6.3 ± 4.2 kg,中位体质量4 kg。结果:平均随访时间62.5 ± 31.1 m(极差36—98 m),有28例(12.2%)患者ASO术后出现了中重度的NAR。在Kaplan-Meier生存曲线中,ASO术后1年、2年、3年、5年免除中重度NAR的概率依次为100.0%、100.0%、99.6%及95.3%。在单因素分析的结果中,出现中重度NAR的患者接受ASO时的体质量、术前伴有肺动脉.高压的比例和前期左室训练术的比例均明显大于无或微少量NAR的患者[(8.3 ±5.6)kg vs.(5.8 ± 4.3)kg,P=0.006;50.0%vs.20.4%,P=0.001;28.6%vs.10.4%,P=0.013)]。在多因素分析的结果中,患者接受ASO前期的左室训练术(HR=3.8,P=0.005)以及术前伴有肺动脉高压(HR=16.5,P0.001)提示为术后中重度NAR的危险因素。结论:TGA患者ASO术后的中重度NAR的发生率较为满意,术前伴有肺动脉高压以及前期左室训练术术被提示与NAR的发生相关。目的:完全性大动脉转位(transposition of the great arteries,TGA)伴肺动脉高压(pulmonary arterial hypertension,PAH)的患者在动脉调转术(arterial switch operation,ASO)后的预后情况研究较少。本研究即对这类患者的近中期预后进行分析。方法:从2010年1月到2014年12月,回顾性连续纳入83例TGA-PAH患者的临床资料,纳入标准包括:1)诊断为TGA伴非限制性(3mm)室间隔缺损(ventricular septal defect,VSD);2)年龄6个月;3)接受ASO治疗;4)平均肺动脉压力(mean pulmonary artery pressure,mPAP)25 mmHg/肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)15 mmHg。另外,伴体肺侧枝循环、左室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)和心脏位置异常的患者被排除。结果:平均随访时间39.6 ± 32.4 m,共纳入83例患者,死亡率13.3%(11/83)。50例≤ 1岁的患者为A组,33例1岁的患者为B组。8例(72.7%)患者因PAH死亡,均发生在ASO术后1年内。患者6个月,1年,5年免于PAH相关的死亡率分别为93.6%,89.5%和89.5%。ASO术后即时mPAP在多因素分析中提示为死亡的独立危险因素(OR=3.257,p=0.030)。随访中TGA-VSD-PAH患者的中重度新主动脉瓣反流(neoaortic regurgitation,NAR)的发生率为 11.1%。结论:年龄小于1岁的TGA-VSD-PAH患者ASO术后的结果较年龄大于1岁的患者有更好的生存率和预后。患者的死亡可能和ASO术后即时测定的mPAP有关。mPAP异常的患者接受常规药物治疗可能对ASO的预后有益。
[Abstract]:Objective: to analyze the risk factors of neoaortic regurgitation in patients with complete transposition of the great arterias (TGA) after transposition of arterial switch operation (ASO). Methods: from January 2008 to January 2013, The clinical data of 229 TGA patients who received ASO therapy were retrospectively included, followed up, and focused on the NAR after ASO. The basic condition of 229 patients was 173 males and 56 females. The mean age was 7.8 卤15.9 m, median age 1.5 m, body mass 2.4 ~ 18 kg / kg, mean body mass 6.3 卤4.2 kg, median body mass 4 kg.Results: average follow-up time was 62.5 卤31.1 m (36-98 mm). There were moderate and severe NARs in the survival curve of Kaplan-Meier after ASO. The probability of eliminating moderate and severe NAR in 1 year, 2 years, 3 years and 5 years after Kaplan-Meier survival was 100.0% and 99.6% respectively, and 95.3% in the single factor analysis. The body mass of patients with moderate and severe NAR was significantly higher than that of patients without or without NAR (8.3 卤5.6kg vs.(5.8 卤4.3g / kg). The proportion of hypertension with pulmonary artery before operation was significantly higher than that of patients without or without a small amount of NAR [8.3 卤5.6kg vs.(5.8 卤4.3g / kg vs.(5.8 0.006 卤0.06v s.20.4p ~ (0.001) 28.6vs.10.4p ~ (0.013)]. Among the results of multivariate analysis, The risk factors of moderate and severe NAR were suggested to be the risk factors of moderate and severe NAR in patients undergoing left ventricular training prior to ASO (3. 8% P0. 005) and with pulmonary hypertension before operation (P 0. 001). Conclusion the incidence of moderate and severe NAR after ASO in patients with ASO is satisfactory. Preoperative pulmonary hypertension and early left ventricular training were suggested to be associated with the occurrence of NAR. Objective: to study the preconditioning of NAR in patients with complete transposition of the great arteriosurgery (TGA) and pulmonary arterial hypertensionsion (PAH) after arterial transposition and arterial switch operation. In this study, the near to medium term prognosis of these patients was analyzed. Methods: from January 2010 to December 2014, The clinical data of 83 patients with TGA-PAH were included retrospectively. The inclusion criteria included: 1) diagnosis of TGA with unrestricted 3 mm) ventricular septal defect ventricular septal defectVSD 2) age 6 months 3) received ASO treatment 4) mean pulmonary artery pressure of 25 mm HgG / pulmonary capillary wedge pressure PCWP15 mm Hg.At the same time, the pulmonary collateral circulation was associated with pulmonary collateral circulation. The patients with left ventricular outflow tract obstruction and abnormal cardiac location were excluded. Results: the mean follow-up time was 39.6 卤32.4 m. The mortality rate was 13.3% 83%. 50 patients 鈮，

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