本文選題：心血管畸形 + 血管移植�。� 參考：《中國(guó)循環(huán)雜志》2017年09期

【摘要】：目的:總結(jié)左冠狀動(dòng)脈起源于肺動(dòng)脈(ALCAPA)合并重度左心功能不全患者的外科治療結(jié)果。方法:回顧性分析2009-02至2016-04,我院小兒外科中心采用冠狀動(dòng)脈再植治療ALCAPA合并重度左心功能不全患者[左心室射血分?jǐn)?shù)(LVEF)30%]24例,男性13例,中位年齡7.0(5.0,17.8)個(gè)月,術(shù)前中位LVEF值為21.0%(17.3%,26.5%)。結(jié)果:24例患者院內(nèi)死亡2例(8.3%),體外循環(huán)中位時(shí)間109(95,128)min,主動(dòng)脈阻斷中位時(shí)間65(48,87)min,呼吸機(jī)輔助中位時(shí)間94.5(48.3,165.5)h,住重癥監(jiān)護(hù)病房中位時(shí)間176.5(101.0,305.3)h,2例患者行體外膜肺氧合(ECMO)輔助并成功脫機(jī),二次氣管插管2例。22例患者出院時(shí)LVEF為26.0%(20%,35%)與術(shù)前比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。22例患者平均隨訪時(shí)間(15.3±14.9)個(gè)月,最長(zhǎng)隨訪63個(gè)月,隨訪期間無(wú)再次入院、再次手術(shù)和死亡,心功能分級(jí)均為紐約心臟協(xié)會(huì)(NYHA)心功能分級(jí)Ⅰ級(jí),最后一次隨訪LVEF 60%(50%,69%)較出院時(shí)顯著提高(P0.05),4例患者LVEF50%。結(jié)論:對(duì)于ALCAPA合并重度左心功能不全的患者,外科治療仍具有滿意的近中期效果,其圍術(shù)期處理強(qiáng)調(diào)外科、麻醉、體外循環(huán)以及術(shù)后監(jiān)護(hù)室的綜合努力。
[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 鹵14.9m). The average follow-up time was 15.3 鹵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，

本文編號(hào)：1933324