婴幼儿主动脉缩窄一期手术治疗28例临床总结.doc

婴幼儿主动脉缩窄一期手术治疗28例临床总结【摘要】：p 】：】目的 讨论婴幼儿主动脉缩窄一期手术的外科治疗经历。方法 28例患儿其中22例在全麻低温体外循环选择性脑灌注下行手术治疗，采用胸部正中切口；6例单存主动脉弓缩窄那么采用左后外侧切口非体外循环下行手术治疗。手术前均穿刺并术中术后监测上下肢血压，22例78.6%合并室间隔缺损和其他心内畸形：6例21.4%为单存主动脉弓缩窄；10例35.7%伴有严重主动脉弓发育不良，导管前型20例71.4%，导管后型5例17.8%，部分狭窄3例10.7%。采用缩窄段切除及对端吻合16例，缩窄段切除加扩大的端端吻合Resection with e_tended end-to-end anastomosis10例，部分补片2例。术后呼吸机辅助呼吸大于3 d，给予前列腺素E1降肺动脉高压。结果 28例手术顺利，术后下肢血压升高压差均小于20 mmHg。1例合并肺炎并呼吸功能不全，花费高，家长放弃治疗，1例心功能不全死亡，3例术后高血压口服卡托普利处理，死亡率7.14%。结论 掌握手术适应症，采用恰当手术方式，减少术后剩余缩窄，是手术成功的关键。【中图文分类号】R654.2 【文献标识码】B【关键词】：p 】：】婴幼儿主动脉缩窄手术治疗【Abstract】Objective to e_plore the infants and young children the e_perience of surgical treatment of aorta issue of surgery.Methods 28 cases of which 22 cases in e_tracorporeal circulation in low temperature selective cerebral perfusion during anesthesia downlink surgery， using the center of the chest incision.6 cases of single deposit aortic arch narrow in left posterolateral incision under e_tracorporeal circulation operation.Preoperative biopsy and postoperative monitoring intraoperative onset of blood pressure， 22 cases 78.6% of ventricular septal defect and other heart malformations： 6 cases 21.4% for single aortic arch narrowed； 10 cases 35.7% with severe aortic arch hypoplasia， catheter type before 20 cases 71.4%， after catheter type 5 cases 17.8%， local stenosis in 3 patients 10.7%.Using narrow segment Resection and to end anastomosis in 16 cases， e_panding narrowed segment Resection with end to end anastomosis Resection with e_tended end - to - end anastomosis 10 cases， local patch in 2 cases.Postoperative respiratory machine help to breathe more than 3 days， giving prostaglandin E1 down pulmonary hypertension.Results 28 cases operation smoothly， postoperative lower limb blood pressure rises high pressure difference are less than 20 MMHG.1 case with pneumonia and respiratory insufficiency， cost is high， the parents to give up treatment， 1 case of cardiac insufficiency died， 3 cases of postoperative hypertension oral captopril treatment， mortality is 7.14%.Conclusion master the operation indications， adopt proper surgery way， reduce the postoperative residual narrow， is the key to successful operation.【Key words】infant coarctation of the aorta operation treatment主动脉缩窄是指胸主动脉的一种先天性重度狭窄，发病率在先天性心脏病中约占5%10%。缩窄段常发生在动脉导管或动脉韧带与主动脉连接的相邻部位。我院自2022年7月20_年7月在全麻低温体外循环选择性脑灌注下行主动脉瓣狭窄矫治术22例，非体外循环手术6例，手术效果满意，现总结如下：1 资料与方法1.1 临床资料患儿男21例，女7例。手术年龄1个月3岁平均13.5±2.5个月，体重3.315.0 kg平均7.3 ±2 kg；22例78.6%合并室间隔缺损和其他心内畸形；6例21.4%为单存主动脉弓缩窄，10例35.7%伴有严重主动脉弓发育不良，导管前型20例71.4%，导管后型5例17.8%，部分狭窄3例10.7%所有病例均经超生心动图明确诊断，主动脉弓影像采用64排心脏大血管增强造影获得。主动脉弓发育不良的诊断标准：近端主动脉弓横部无名动脉与左颈总动脉之间直径小于等于升主动脉直径的60%，远端主动脉弓横部左颈总动脉与左锁骨下总动脉之间直径小于等于升主动脉直径的50%，主动脉峡部左锁骨以下直径小于等于升主动脉直径的40%。第 4 页 共 4 页