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目的评价大动脉调转术治疗年龄6个月以上重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者的中期疗效。方法对86例年龄6个月以上的重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者行大动脉调转手术,观察术后病死率、并发症发生率、术后肺动脉压力等,分析手术死亡、术后持续性肺动脉高压的影响因素。结果本组住院死亡6例(6.98%),72例完成随访,死亡2例;存活者心功能NYHAⅡ级2例(2.86%),心功能NYHAⅠ级68例(97.14%);术后肺动脉压(30.5±13.0)mm Hg明显低于术前(64.9±13.0)mm Hg,经皮血氧饱和度(99.7±0.7)%明显高于术前(72.0±15.0)%(P<0.05);多因素回归分析显示,术后肺动脉高压、一氧化氮吸入、血浆胶体渗透压监测是手术死亡的独立预测因子(OR=1.236,95%CI:1.080~1.415,P=0.002;OR=0.016,95%CI:0.001~0.345,P=0.008;OR=0.070,95%CI:0.006~0.829,P=0.035),手术年龄与持续性肺动脉高压独立相关(OR=1.283,95%CI:1.073~1.536,P=0.006)。结论大动脉调转术治疗大龄重度肺动脉高压伴室间隔缺损、大动脉转位和Taussig-Bing畸形患者中期效果良好。
Objective To evaluate the medium-term effect of aortic transfer in the treatment of patients with severe pulmonary hypertension with ventricular septal defect, aortic transposition and Taussig-Bing deformity who are more than 6 months old. Methods 86 cases of severe pulmonary hypertension with ventricular septal defect, aortic transposition and Taussig-Bing deformity underwent aortic transfer in more than 6 months. The postoperative mortality, the incidence of complications and the postoperative pulmonary pressure were analyzed. Surgical mortality and postoperative persistent pulmonary hypertension. Results There were 6 deaths (6.98%) in hospital and 72 deaths in 2 cases. The survivors were NYHA class Ⅱ (68 cases) (97 cases), heart function NYHA class Ⅱ (68 cases), postoperative pulmonary arterial pressure 30.5 ± 13.0 mm Hg was significantly lower than preoperative 64.9 ± 13.0 mm Hg and 99.2 ± 0.7% was significantly higher than preoperative 72.0 ± 15.0% (P <0.05) Regression analysis showed that postoperative pulmonary hypertension, nitric oxide inhalation, and plasma colloid osmolality monitoring were independent predictors of operative mortality (OR = 1.236, 95% CI: 1.080-1.415, P = 0.002; OR = 0.016, 95% CI (OR = 1.283, 95% CI: 1.073-1.536, P = 0.008; OR = 0.070, 95% CI: 0.006-0.829, P = 0.035) 0.006). Conclusion Aortic transposition in elderly patients with severe pulmonary hypertension with ventricular septal defect, aortic transposition and Taussig-Bing deformity in patients with good effect.