肺动脉束带术在治疗复杂型先天性心脏病中的临床应用.doc

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1、肺动脉束带术在治疗复杂型先夭性心脏病中的临床应用岭南心血管病杂志2000年第1期第6卷论著作者：陈欣欣张镜方庄建吴若彬岑坚正陈寄梅单位：510100广州市广东省人民医院关键词：肺动脉束带术；复杂型先天性心脏病；姑息手术【摘要】目的探讨肺动脉束带术(PAB)在治疗复杂型先天性心脏病中的应用价值。方法1997年5月至1998年11月，在我科住院的8例患儿，年龄4个月〜8岁，平均(3.3±2.5)岁，体重4.5〜17kg,平均(10.8±3.8)kg,经心导管检杏及造影诊断为复杂型先天性心脏病伴肺动脉高压且无一期根治手术指征。6例施行体外循环手术，其中5例先行房间隔造口术，3例合并

2、动脉导管未闭者予以结扎或缝扎；再按Trusler的方法施行PAB；2例在非体外循环下行PAB。结果术后肺动脉压力32〜40mmHg,动脉血氧饱和度(SaO2)为85%~95%°随访2〜20个月，肺炎及充血性心力衰竭明显减少或消失，SaO2维持在80%〜97%,超声心动图检测跨肺动脉束带处压力阶差为44〜67.6mmHg。无手术死亡及严重并发症。结论PAB可•作为部分复杂型先天性心脏病的过渡型姑息手术，为以后的二期手术创造条件；亦可作为较大龄高危患儿的终结性姑息手术，改善生活质量。Theclinicalapplicationofpulmonaryarterybandingint

3、reatingcomplicatedcongenitalheartdiseasesChenXinxin,ZhangJingfang,ZhuangJian,etal.DepartmentofCardiovascularSurgery,GuangdongProvincialHospital,Guangzhou510100[Abstract]ObjectiveTostudytheresultsandcurrentindicationsofpulmonaryarterybandingintreatingcomplicatedcongenitalheartdiseases.Method

4、8child-renwithcongenitalheartdefectscharacterizedbyexcessivepulmonarybloodflowunderwentpulmonaryarterybandingatGuangdongProvincialHospitalfromMay1997throughNovember1998.Thepatientsaged4monthsto8years[mean,(3.3±2.5)years]andweighing4.5to17.0kg[mean,(10.8±3.8)kg].AllPatientsunderwentdiagnosti

5、ccardiaccatheterization,angiographyandechocardiography.Pulmonaryarterybandingwasperformedin8cases,undercardiopulmonarybypassin6cases.Atrialseptectomywasperformedin5casesandductusligationin3cases.WeestimatedrequiredbandcircumferenceaccordingtoTruslersmethod.ResultsNoearlydeathandseverecompli

6、cation.Thepulmonaryarterypressurewas32to40mmHg(systolic)andarterysatuationwas85%〜95%postoperatively.Followup2to20months,congestiveheartfailuredecreasedobviouslyordisappeared.Thearterysatuationwas80%〜97%andpressuregradientacuossthebandwas44to67.6mmHgbyechocardiography.ConclusionsPulmonaryart

7、erybandingremainsaneffectivemeansofachievingsatisfactorypalliationininfantswithcongenitalheartdiseases,reducespulmonaryarterypressureandimprovesclinicalsymptoms.ItcouldbethelastPalliativeoperationinolderchildrenwithsomecomplexanomalies.[Keywords]Pulmonar