摘要
目的分析法洛四联症根治手术早期死亡的相关危险因素,探讨改善疗效的方法。方法常规体外循环心脏停跳下行法洛四联症根治手术,从手术适应症、手术方法、心肌保护、术后处理等方面总结近3年356例根治术后早期20例死亡患者的可能高危因素。结果11例死于早期低心排综合征,4例死于呼吸衰竭(1例因窒息死亡),3例死于肾功能衰竭或多脏器衰竭,1例死于急性左心衰竭,1例死于脑血管意外。结论年龄小、肺血管及左室发育差是术后低心排发生的高危因素;手术技巧及畸形矫治方法是导致术后死亡的主要原因;良好的体外循环转流及心肌保护是根治术成功的基本保障;正确的术后治疗处理及严密的监护是降低术后死亡的重要步骤。
Objective To identify the risk factors of early postoperative death after total correction of tetralogy of Fallot （TOF）. Methods A retrospective analysis was conducted among 356 patients undergoing total correction of TOF by opening heart surgery and cardiopulmonary bypass. Of these patients, 20 died in the early postoperative period, and the possible risk factors for early postoperative death were analyzed in view of the surgical indication, surgical approaches, myocardial protection and postoperative management. Results Of the 20 fatal cases, death occurred due to low cardiac output syndrome in 11 eases, respiratory failure in 4 cases, kidney failure or multiple organ failure in 3 cases, acute left heart failure in 1 ease, and cerebrovascular accident in 1 case. Conclusions Young age at repair and poor development of the pulmonary vessels and left ventricle are high risk factors for postoperative low cardiac output syndrome. Postoperative death following surgical correction of TOF is associated mainly with the surgical skills and approaches. Appropriate cardiopulmonary bypass and effective measures for myocardial protection are critical to ensure the surgical success, and proper postoperative management and close monitoring may help reduce postoperative death in surgical patients with TOF.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2009年第6期1150-1152,共3页
Journal of Southern Medical University
基金
广东省自然科学基金(8151001002000025)
关键词
法洛四联症
根治术
死亡原因
心肌保护
低心排综合征
tetralogy of Fallot
total correction
postoperative death
risk factors
myocardial protection
low cardiac output syndrome
