本文關(guān)鍵詞： 完全性大動(dòng)脈轉(zhuǎn)位 大動(dòng)脈調(diào)轉(zhuǎn)術(shù) 新主動(dòng)脈瓣反流 完全性大動(dòng)脈轉(zhuǎn)位 肺動(dòng)脈高壓 大動(dòng)脈調(diào)轉(zhuǎn)術(shù) 新主動(dòng)脈瓣反流　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析完全性大動(dòng)脈轉(zhuǎn)位(transposition of the great arteries,TGA)的患者在動(dòng)脈調(diào)轉(zhuǎn)術(shù)(arterial switch operation,ASO)后出現(xiàn)新主動(dòng)脈瓣反流(neoaortic regurgitation,NAR)的危險(xiǎn)因素。方法:從2008年1月到2013年1月,回顧性納入接受ASO治療的229例TGA患者的臨床資料,并對(duì)患者進(jìn)行跟蹤隨訪,重點(diǎn)關(guān)注ASO術(shù)后患者NAR的情況。229例患者基本情況為男173例,女56例,年齡范圍3天(d)到93.9月(m),平均年齡7.8 ± 15.9 m,中位年齡1.5m,體質(zhì)量范圍2.4到18千克(kg),平均體質(zhì)量6.3 ± 4.2 kg,中位體質(zhì)量4 kg。結(jié)果:平均隨訪時(shí)間62.5 ± 31.1 m(極差36—98 m),有28例(12.2%)患者ASO術(shù)后出現(xiàn)了中重度的NAR。在Kaplan-Meier生存曲線中,ASO術(shù)后1年、2年、3年、5年免除中重度NAR的概率依次為100.0%、100.0%、99.6%及95.3%。在單因素分析的結(jié)果中,出現(xiàn)中重度NAR的患者接受ASO時(shí)的體質(zhì)量、術(shù)前伴有肺動(dòng)脈.高壓的比例和前期左室訓(xùn)練術(shù)的比例均明顯大于無(wú)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)]。在多因素分析的結(jié)果中,患者接受ASO前期的左室訓(xùn)練術(shù)(HR=3.8,P=0.005)以及術(shù)前伴有肺動(dòng)脈高壓(HR=16.5,P0.001)提示為術(shù)后中重度NAR的危險(xiǎn)因素。結(jié)論:TGA患者ASO術(shù)后的中重度NAR的發(fā)生率較為滿意,術(shù)前伴有肺動(dòng)脈高壓以及前期左室訓(xùn)練術(shù)術(shù)被提示與NAR的發(fā)生相關(guān)。目的:完全性大動(dòng)脈轉(zhuǎn)位(transposition of the great arteries,TGA)伴肺動(dòng)脈高壓(pulmonary arterial hypertension,PAH)的患者在動(dòng)脈調(diào)轉(zhuǎn)術(shù)(arterial switch operation,ASO)后的預(yù)后情況研究較少。本研究即對(duì)這類患者的近中期預(yù)后進(jìn)行分析。方法:從2010年1月到2014年12月,回顧性連續(xù)納入83例TGA-PAH患者的臨床資料,納入標(biāo)準(zhǔn)包括:1)診斷為T(mén)GA伴非限制性(3mm)室間隔缺損(ventricular septal defect,VSD);2)年齡6個(gè)月;3)接受ASO治療;4)平均肺動(dòng)脈壓力(mean pulmonary artery pressure,mPAP)25 mmHg/肺毛細(xì)血管楔壓(pulmonary capillary wedge pressure,PCWP)15 mmHg。另外,伴體肺側(cè)枝循環(huán)、左室流出道梗阻(left ventricular outflow tract obstruction,LVOTO)和心臟位置異常的患者被排除。結(jié)果:平均隨訪時(shí)間39.6 ± 32.4 m,共納入83例患者,死亡率13.3%(11/83)。50例≤ 1歲的患者為A組,33例1歲的患者為B組。8例(72.7%)患者因PAH死亡,均發(fā)生在ASO術(shù)后1年內(nèi)�；颊�6個(gè)月,1年,5年免于PAH相關(guān)的死亡率分別為93.6%,89.5%和89.5%。ASO術(shù)后即時(shí)mPAP在多因素分析中提示為死亡的獨(dú)立危險(xiǎn)因素(OR=3.257,p=0.030)。隨訪中TGA-VSD-PAH患者的中重度新主動(dòng)脈瓣反流(neoaortic regurgitation,NAR)的發(fā)生率為 11.1%。結(jié)論:年齡小于1歲的TGA-VSD-PAH患者ASO術(shù)后的結(jié)果較年齡大于1歲的患者有更好的生存率和預(yù)后�；颊叩乃劳隹赡芎虯SO術(shù)后即時(shí)測(cè)定的mPAP有關(guān)。mPAP異常的患者接受常規(guī)藥物治療可能對(duì)ASO的預(yù)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 鹵15.9 m, median age 1.5 m, body mass 2.4 ~ 18 kg / kg, mean body mass 6.3 鹵4.2 kg, median body mass 4 kg.Results: average follow-up time was 62.5 鹵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 鹵5.6kg vs.(5.8 鹵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 鹵5.6kg vs.(5.8 鹵4.3g / kg vs.(5.8 0.006 鹵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 鹵32.4 m. The mortality rate was 13.3% 83%. 50 patients 鈮，

本文編號(hào)：1543213