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

【摘要】：目的:總結(jié)左冠狀動脈起源于肺動脈(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脈再植治療ALCAPA合并重度左心功能不全患者[左心室射血分數(shù)(LVEF)30%]24例,男性13例,中位年齡7.0(5.0,17.8)個月,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)中位時間109(95,128)min,主動脈阻斷中位時間65(48,87)min,呼吸機輔助中位時間94.5(48.3,165.5)h,住重癥監(jiān)護病房中位時間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,二次氣管插管2例。22例患者出院時LVEF為26.0%(20%,35%)與術(shù)前比較差異無統(tǒng)計學(xué)意義(P0.05)。22例患者平均隨訪時間(15.3±14.9)個月,最長隨訪63個月,隨訪期間無再次入院、再次手術(shù)和死亡,心功能分級均為紐約心臟協(xié)會(NYHA)心功能分級Ⅰ級,最后一次隨訪LVEF 60%(50%,69%)較出院時顯著提高(P0.05),4例患者LVEF50%。結(jié)論:對于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)期處理強調(diào)外科、麻醉、體外循環(huán)以及術(shù)后監(jiān)護室的綜合努力。
[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：1933324