Page 17 - 麻醉与监护论坛2015年第7期

李晓密 韩宏光 李新民 王辉山 摘要
方敏华 尹宗涛 韩劲松 孟庆涛
目的：评价膨体聚四氟乙烯片（Gore-Tex片）作肺动脉单瓣重建右室流出道(R V O T)的近期疗
沈阳军区总医院心血管外科 辽宁沈阳 110016 效。方法：2002年6月-2011年11月对75例先天性心脏病合并肺动脉狭窄或闭锁的患者施行矫治手
术，术中采用厚度0.1m m的G o r e-T e x片作肺动脉单瓣重建R V O T，其中男42例，女33例。法洛四联
症合并肺动脉狭窄57例，I型肺动脉闭锁1O例，肺动脉瓣缺如4例，右心室双出口合并肺动脉狭窄
2例，完全型大动脉转位1例，室间隔缺损1例，肺动脉狭窄1例。结果：术后血氧饱和度为96%～
100%，动脉血氧分压82～207m m H g，右室／左室收缩压比值0.22～0.70，右室与左、右肺动脉间的
压力阶差小于10mmHg。左室射血分数（LVEF）0.53～O.80，右室射血分数（RVEF）0.52～0.71，左
室舒张末期容积指数（L V E D I）0.28～0.62m l／m2。术后早期并发症：心包积液7例，低氧血症（氧
合指数<150）6例，心律失常5例，低心排血量综合征4例，残余室间隔缺损4例。术后随访3～48个
月，无死亡和并发症的发生，其中62例Gore-Tex片作肺动脉单瓣重建右心室流出道(RVOT)早期瓣膜
活动功能正常，13例单瓣固定在开放状态；72例均无肺动脉单瓣狭窄，3例单瓣轻度狭窄；21例肺
动脉瓣轻度返流，5例中度返流。结论： 采用厚度0.1mm的Gore-Tex片作单瓣重建RVOT，可获得满
意的临床和血流动力学效果，近期效果良好。膨体聚四氟乙烯片作单瓣重建右心室流出道术后早期
并发症应引起高度重视，加强术后监护及综合治疗措施，及时纠正术后低心输出量综合征，积极防
治术后心律失常等均为提高手术成功率的重要因素。

关键词：先天性心脏病；膨体聚四氟乙烯；右室流出道重建术；手术后并发症
责任作者及联系方式：韩宏光，E-mail: Hanxiyao@163.com

膨体聚四氟乙烯片作单瓣重建右室流出道术

后早期并发症及处理

Early Complications and its Management after Right Ventricular Outlet Tract

Reconstruction with Gore-tex Monocusp Valve

Xiao-mi Li, Hong-guang Han, Xin-min Li, Hui-shan Wang, Min-hua Fang, Zong-tao Yin, Jin-
song Han, Qing-tao Meng

Department of Cardiac Surgery, General Hospital of Shenyang Military District, Shenyang, 110016, Liaoning

Province, China

Abstract

Objective: To evaluate the efficacy of reconstruction of right ventricular outlet tract(RVOT)with 0.1 mm Gore-Tex monocusp valve for short term.
Methods: Between June 2002 to June 2010, 75 patients (42 male, 33 female) underwent reconstruction of RV0T with Gore-Tex monocusp valve to
correct cardiac anomalies，including 57 patients with tetralogy of Fallot (TOF) and pulmonary stenosis, 10 patients with TOF and pulmonary atresia,
4 patients with TOF and absent pulmonary valve, 2 patients with double outlet of right ventricle and pulmonary stenosis, 1 patient with truncus arterious
and 1 patient with complete transposition of great artery, ventricular septal defect and pulmonary stenosis.
Results: There was no operative death. The postoperative blood oxygen saturation was up to 96%-100%. PaO2 was 82-207mmHg. The ratioes of right
ventricular systolic pressure and left ventricular systolic pressure were between 0.22 to 0.70.The gradient between right ventricle and left or right pulmonary
artery was less than 10 mmHg; Left ventricular ejection fraction (LVEF) was 0.53-0.80, right ventricular ejection fraction (RVEF) was 0.52-0.71, left
ventricular end-diastolic volume index was 0.28-0.62ml/m2. Early postoperative complications: hypoxemia (oxygenation index <150) in 6 cases, low cardiac
output syndrome in 4 cases, arrhythmia in 5 cases, 7 cases pericardial effusion, 4 cases of residual ventricular septal defects. All patients were followed up
including echocardiography ranged from 3 to 48 months. There were no late death and complications. 62 cases early valve activities function was normal, 13
patients single lobe fixed in the open state, 72 patients were not pulmonary stenosis, 3 patients mild stenosis; 21 cases mild pulmonary valve regurgitation , 5
cases moderate regurgitation.
Conclusion: The results suggest that reconstruction of RVOT with 0.1 mm Gore-Tex monocusp valve can secure a satisfactory clinical and
hemodynamic effects of the recent good results.Strict，intensive surveillance and promptly synthesized treatment for low cardiac output syndrome,
cardiac arrhythmia can improve the operative results, Early therapy may effectively avoid negative consequence of postoperative serious complication.
Key Words: Congenital heart disease; Gore-Tex; Right ventricular outflow tract reconstruction; Postoperative complications
Corresponding Author: Hong-guang Han, E-mail: Hanxiyao@163.com

跨瓣环补片加宽右心室流出道(r i g h t v e n t r i c u l a r 长期肺动脉瓣反流可致右室容量及压力负荷增加，使右室发
outlet tract，RV0T)在合并重度肺动脉瓣狭窄、发育不良 生重构，造成心室功能发生改变，运动耐力下降和心力衰竭
或闭锁的复杂先天性心脏病的外科修复手术中占有重要地 [1]。我院2002年6月-2011年11月对75例先天性心脏病合并肺
位，但R V O T狭窄解除的同时往往会造成肺动脉瓣的反流，而 动脉狭窄或闭锁的患者采用半圆形、厚度0.1m m的膨体聚四

Laboratory and Clinical Investigation 45 FAM 2013 Jan/Feb Vol.20 Issue 1
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