【摘要】：目的總結(jié)外科治療嬰兒法洛四聯(lián)癥(TOF)的臨床經(jīng)驗(yàn),并對早期、中期療效進(jìn)行評價。方法 142例嬰兒TOF,術(shù)前經(jīng)心臟彩超和(或)心臟CTA檢查確診,其中男性79例,女性63例;年齡1~12個月,平均(6.4±2.7)個月;體質(zhì)量3.0~12.0kg,平均(6.7±1.4)kg。McGoon值0.80~2.47,平均1.59±0.34;左室舒張末容積指數(shù)14.0~36.3mL/m2,平均(25.5±5.9)mL/m2。138例在中度低溫體外循環(huán)下行一期根治術(shù),4例行分期根治手術(shù)。結(jié)果體外循環(huán)時間(95.0±21.7)min,主動脈阻閉時間(54.3±15.1)min,術(shù)后呼吸機(jī)輔助時間(40.2±30.5)h,監(jiān)護(hù)室停留時間(5.0±3.5)d。治愈出院140例,死亡2例(院內(nèi)死亡率1.4%)。術(shù)后二次手術(shù)4例(2.8%)。術(shù)后并發(fā)癥主要為低心排出量綜合征、肺部感染、急性腎衰竭等,并發(fā)癥發(fā)生率為7.0%(10/142)。隨訪患兒127例,隨訪率89.4%,隨訪時間11~62個月(中位數(shù)37個月),均無死亡或再次手術(shù);心功能Ⅰ級117例(92.1%),心功能Ⅱ級10例(7.9%);心臟超聲提示右室射血分?jǐn)?shù)(EF)均正常,微量或少量肺動脈瓣反流113例(89.0%),中量反流14例(11.0%),無大量反流。結(jié)論嬰兒期行TOF根治術(shù)是安全有效的,優(yōu)化手術(shù)方法及加強(qiáng)圍手術(shù)期管理是提高嬰兒期TOF手術(shù)成功率的關(guān)鍵,術(shù)后早期和中期療效滿意。
[Abstract]:Objective to summarize the clinical experience of surgical treatment of tetralogy of Fallot (TOF) in infants and to evaluate the early and intermediate effects. Methods 142 infants (79 males and 63 females) were diagnosed by echocardiography and / or cardiac CTA before operation. The age ranged from 1 to 12 months (mean (6.4 鹵2.7) months). The mean body mass was (6.7 鹵1.4) kg 路McGoon 0.80 鹵2.47, mean 1.59 鹵0.34, and left ventricular end-diastolic volume index 14.0 ~ 36.3 mL / m ~ (2), mean (25.5 鹵5.9) mL 路m ~ (2) 路m ~ (2.138) cases underwent one stage radical surgery under moderate hypothermia cardiopulmonary bypass. The left ventricular end-diastolic volume index was 14.0 鹵36.3 mL / m ~ (2), with an average of (25.5 鹵5.9) mL / m ~ (2.138). Results the CPB time was (95.0 鹵21.7) min, the aortic occlusion time was (54.3 鹵15.1) min, the postoperative ventilator time was (40.2 鹵30.5) h, and the stay time was (5.0 鹵3.5) days. 140 cases were cured and 2 cases died (hospital mortality 1.4%). 4 cases (2.8%) underwent secondary operation after operation. The main postoperative complications were low cardiac output syndrome, pulmonary infection, acute renal failure, etc. The incidence of complications was 7.0% (10 / 142). 127 cases were followed up, the follow-up rate was 89.4%, the follow-up time was 11 ~ 62 months (median 37 months), no death or reoperation, 117 cases (92.1%) of cardiac function grade 鈪，

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