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目的 改进手术方法 ,减少术后低心排 ,提高重型和极重型肺动脉狭窄 (PS)的手术存活率。方法 对 1 9例重型和极重型PS患儿 (男 1 0例 ,女 9例 ,年龄平均 4 4 7± 2 2 1岁 ) ,在中度低温体外循环下 ,采用右心室漏斗部疏通及跨瓣环补片扩大右室流出道的方法进行手术矫治 (其中 7例加做心包单叶瓣 )。结果 1 9例全部存活 ,8例术后有轻度低心排 ,需用小剂量多巴胺 (5 μg·kg-1·min-1)辅助心功能 ,随访 5个月～ 3年 ,心脏超声检查无一例残留右室高压 ,右心室与肺动脉压力差<4kPa(30mmHg)。结论 该方法能增加术后右心室舒张末容积 ,避免右心室残留高压 ,从而减少或减轻术后低心排的发生 ,提高手术存活率。
Objective To improve surgical methods, reduce postoperative low cardiac output, and improve the survival rate of severe and severe pulmonary stenosis (PS). Methods Nineteen male patients with severe and very severe PS (10 males and 9 females with an average age of 447 ± 2121) underwent mild hypothermic cardiopulmonary bypass. Valve ring expansion of right ventricular outflow tract method of surgical correction (including 7 cases plus pericardial single lobe). Results All of the 19 patients survived, and 8 patients had mild low cardiac output. Small doses of dopamine (5 μg · kg-1 · min-1) were required to assist cardiac function. The patients were followed up for 5 months to 3 years. Echocardiography No case of residual right ventricular hypertension, right ventricular and pulmonary artery pressure <4kPa (30mmHg). Conclusion This method can increase the postoperative right ventricular end-diastolic volume and avoid the residual high pressure in the right ventricle, so as to reduce or reduce the incidence of postoperative low cardiac output and improve the surgical survival rate.