论文部分内容阅读
目的分析腔静脉-肺动脉连接术后围术期血栓栓塞的表现、治疗、转归和可能危险因素,评估预防血栓栓塞措施的效果。方法回顾性分析2005年9月至2010年12月期间阜外心血管病医院完成双向Glenn手术264例、全腔静脉-肺动脉连接术(total cavopulmonary connection,TCPC)224例患者的临床资料,其中围术期发生血栓栓塞9例,男5例,女4例;年龄0.9～11.0(5.1±3.7)岁;体重8～30(17±8)kg。5例为双向Glenn手术,4例为TCPC。多数栓塞患者合并至少一个血栓高危因素。术后常规静脉泵入预防量肝素10 U(/kg.h),续以口服阿司匹林1～3 mg(/kg.d)预防血栓。结果 9例中6例血栓栓塞发生于术后7 d之内,3例发生在术后2～4周。9例均给予肝素抗凝治疗,其中1例行下腔静脉-右心房连接术。死亡3例(33%),分别占同期双向Glenn手术和TCPC后早期死亡的33%(1/3)和18%(2/11);其余6例症状和体征改善或消失。结论腔静脉-肺动脉连接术后围术期血栓栓塞的病死率高,是此类手术术后早期死亡的重要原因。围术期预防血栓的策略有效,但仍需注意避免一些相关危险因素。
Objective To analyze the performance, treatment, prognosis and possible risk factors of perioperative thromboembolism after vena cava-pulmonary artery connection and to evaluate the effect of thromboembolism prevention measures. Methods The clinical data of 264 patients who underwent two-way Glenn operation and 224 patients under total cavopulmonary connection (TCPC) were retrospectively analyzed from September 2005 to December 2010 in Fu Wai Hospital. Among them, There were 9 cases of thromboembolism during the operation, including 5 males and 4 females, aged from 0.9 to 11.0 (5.1 ± 3.7) years and weight ranging from 8 to 30 (17 ± 8) kg. Five patients were bi-directional Glenn surgery and four patients were TCPC. Most embolic patients have at least one risk factor for thrombosis. Postoperative conventional intravenous prophylaxis of heparin 10 U (/ kg.h), continued oral aspirin 1 ~ 3 mg (/ kg.d) to prevent thrombosis. Results Among the 9 cases, 6 cases occurred thromboembolism within 7 days after operation and 3 cases occurred within 2 to 4 weeks after operation. Nine patients were given heparin anticoagulant therapy, including 1 case of inferior vena cava - right atrial connection. Three patients died (33%), accounting for 33% (1/3) and 18% (2/11) of the patients who underwent bilateral Glenn operation and early post-TCPC death, respectively. The remaining 6 patients showed improvement or disappearance of symptoms and signs. Conclusion The high mortality rate of perioperative thromboembolism after intraluminal veno-pulmonary artery connection is an important cause of early postoperative death. Perioperative strategies to prevent thrombosis effective, but still need to be careful to avoid some of the risk factors.