左冠状动脉起源于肺动脉合并重度左心功能不全的外科治疗

发布时间：2018-05-25 13:42

  本文选题：心血管畸形 + 血管移植　； 参考：《中国循环杂志》2017年09期

【摘要】：目的:总结左冠状动脉起源于肺动脉(ALCAPA)合并重度左心功能不全患者的外科治疗结果。方法:回顾性分析2009-02至2016-04,我院小儿外科中心采用冠状动脉再植治疗ALCAPA合并重度左心功能不全患者[左心室射血分数(LVEF)30%]24例,男性13例,中位年龄7.0(5.0,17.8)个月,术前中位LVEF值为21.0%(17.3%,26.5%)。结果:24例患者院内死亡2例(8.3%),体外循环中位时间109(95,128)min,主动脉阻断中位时间65(48,87)min,呼吸机辅助中位时间94.5(48.3,165.5)h,住重症监护病房中位时间176.5(101.0,305.3)h,2例患者行体外膜肺氧合(ECMO)辅助并成功脱机,二次气管插管2例。22例患者出院时LVEF为26.0%(20%,35%)与术前比较差异无统计学意义(P0.05)。22例患者平均随访时间(15.3±14.9)个月,最长随访63个月,随访期间无再次入院、再次手术和死亡,心功能分级均为纽约心脏协会(NYHA)心功能分级Ⅰ级,最后一次随访LVEF 60%(50%,69%)较出院时显著提高(P0.05),4例患者LVEF50%。结论:对于ALCAPA合并重度左心功能不全的患者,外科治疗仍具有满意的近中期效果,其围术期处理强调外科、麻醉、体外循环以及术后监护室的综合努力。
[Abstract]:Objective: to summarize the results of surgical treatment of patients with severe left ventricular insufficiency (ALCAPA), whose left coronary artery originated from pulmonary artery. Methods: from 2009-02 to 2016-04, 24 patients with ALCAPA complicated with severe left ventricular insufficiency were treated with coronary artery replantation [30% of left ventricular ejection fraction] in our pediatric surgical center. The median LVEF value was 21.0 17.3% and 26.5%, respectively. Results 2 cases died in hospital, 2 cases died in hospital, the median time of cardiopulmonary bypass (CPB) was 109 ~ 95128min, the median time of aorta occlusion was 65 ~ 48 ~ 87min, the median time of ventilator assistance was 94.5g / h 48.3165.5 / h, the median time of staying in intensive care unit was 176.5101.0305.3hU / h, and two patients were given ECMO-assisted and successfully weaned by extracorporeal membrane oxygenation (ECMOMOA). There was no significant difference between the two patients with secondary tracheal intubation (LVEF = 26.020) and the preoperative patients (P 0.05 卤14.9m). The average follow-up time was 15.3 卤14.9months. The longest follow-up period was 63 months. There was no re-admission, reoperation and death during the follow-up period. The cardiac function grades were all grade 鈪，

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