發(fā)布時(shí)間：2018-01-08 22:25

  本文關(guān)鍵詞：Switch術(shù)治療完全性大動(dòng)脈轉(zhuǎn)位的臨床分析　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 完全性大動(dòng)脈轉(zhuǎn)位 Switch術(shù) 年齡 危險(xiǎn)因素

【摘要】：目的：總結(jié)我院Switch術(shù)治療完全性大動(dòng)脈轉(zhuǎn)位患兒的療效，回顧性分析Switch術(shù)療效與手術(shù)年齡的關(guān)系，總結(jié)死亡危險(xiǎn)因素，提高我院本病的臨床診治水平，提高存活率。 材料與方法：收集我院2003年3月至2014年2月期間在本院診斷為完全性大動(dòng)脈轉(zhuǎn)位并行Switch術(shù)的57例患兒住院資料。男48例，女9例，手術(shù)年齡3天到6歲10月（平均136.9±352.4d），手術(shù)體重2.6-20Kg（平均4.6±2.8）。根據(jù)是否合并VSD分為2組，IVS組：室間隔完整，VSD組：室間隔缺損。根據(jù)年齡將IVS組分為IVS/eraly（≤14d）、IVS/late（＞14d）兩個(gè)亞組；VSD組分為VSD/eraly（≤28d）、VSD/late（＞28d）兩個(gè)亞組。分別比較兩組內(nèi)各年齡段的體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、術(shù)后ICU治療時(shí)間、術(shù)后機(jī)械通氣時(shí)間、特殊治療、術(shù)后并發(fā)癥（低心排血量綜合征、腎衰竭、二次手術(shù)等）的差異。同時(shí)分析存活患兒與死亡患兒手術(shù)體重、術(shù)前肺炎、伴隨VSD、CPB時(shí)間、阻斷AAO時(shí)間、冠脈畸形、特殊治療及并發(fā)癥之間的差異。 結(jié)果：全組死亡24例，2例放棄治療出院，總體死亡率為42%，逐年死亡率呈下降趨勢(shì)，近兩年死亡率為13%，TGA/IVS、TGA/VSD組間死亡率無明顯差異。IVS/early、IVS/late組間CPB時(shí)間、AAO時(shí)間、術(shù)后特殊治療、術(shù)后并發(fā)癥差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）；VSD/early、VSD/late組間死亡患兒的CPB時(shí)間、阻斷AAO時(shí)間、術(shù)后特殊治療、術(shù)后并發(fā)癥差異均無統(tǒng)計(jì)學(xué)意義（P＞0.05）。死亡患兒組與存活患兒組比較CPB時(shí)間、AAO時(shí)間、術(shù)后低心排血量綜合征差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。術(shù)后復(fù)查UCG示主動(dòng)脈瓣反流多發(fā)生在VSD/late組。 結(jié)論： 1.年齡不是影響Switch手術(shù)療效的決定性因素；術(shù)前綜合評(píng)估TGA/IVS患兒左心室功能、TGA/VSD患兒肺動(dòng)脈壓力，是大齡TGA兒童一期根治的前提。 2.CPB、AAO時(shí)間長、術(shù)后低心排血量綜合征是TGA患兒一期根治預(yù)后危險(xiǎn)因素。 3.我院ASO術(shù)仍有較高死亡率，，隨著外科醫(yī)師的經(jīng)驗(yàn)積累及術(shù)后監(jiān)護(hù)技術(shù)的提高，逐年死亡率已顯著下降，近兩年為13%。
[Abstract]:Objective: to summarize the curative effect of Switch in the treatment of children with complete transposition of the great arteries, analyze the relationship between the curative effect of Switch and the age of operation, and summarize the risk factors of death. Improve the clinical diagnosis and treatment of this disease, improve the survival rate. Materials and methods: from March 2003 to February 2014, 57 children (48 males) who were diagnosed as complete transposition of great arteries and Switch in our hospital were collected. Female 9 cases, the operative age from 3 days to 6 years old October (mean 136.9 鹵352.4 days). The weight of the operation was 2.6-20kg (mean 4.6 鹵2.8g). According to the combination of VSD, the patients were divided into two groups: the ventricular septum was intact. VSD group: ventricular septal defect (VSD). According to the age, the IVS group was divided into two subgroups: the IVS group (鈮

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