中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

单心室心脏分期术后机械循环支持的临床经验

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目的 探讨单心室心脏分期手术后循环衰竭行机械辅助的临床结果及治疗意义。 方法 回顾性分析上海儿童医学中心 2008 年 1 月至 2017 年 6 月心脏术后行机械辅助的 89 例患者的临床资料,对单心室术后需要机械辅助支持的原因、辅助方式、插管特点及临床结果进行总结。 结果 单心室心脏手术后行机械辅助 4 例(4.5%)。3 例为 Glenn 术后,1 例为 B-T 分流术后。辅助方式均为正中经胸的静脉-动脉体外膜肺氧合技术(V-A ECMO)。4 例单心室机械辅助病例,3 例 ECMO 撤机成功,1 例因持续性肺动脉高压放弃治疗。辅助时间为 104(55~504)h。治疗中 1 例,出院 2 例,1 例长期随访中。3 例 ECMO 插管方式为右心房单根静脉回流,仅 1 例 Glenn 术后病例加用上腔静脉插管增加静脉引流量。单心室转流期间的 ECMO 管理常规,同一般 ECMO 常规相似。 结论 单心室术后的辅助循环脱机成功率较低。因根据患儿临床情况尽早启用,以提高存活率。非搏动性血流与波动性血流的机械辅助效果尚待临床验证。针对 Fontan 循环衰竭患儿的长期 VAD 辅助是机械辅助领域最具挑战性的热点。

关键词: 单心室; 机械辅助支持; 体外膜肺氧合; 心室辅助装置

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1. David H, Jennifer C, Ivan MR, et al. Mechanical circulatory support in univentricular hearts: current management. Semin Thorac Cardiovas Surg Pediatr Card Surg Ann. 2015, 18(1): 17-24.
2. Almond CS, Singh TP, Gauvreau K, et al. Extracorporeal membrane oxygenation for bridge to heart transplantation among children in the United States: analysis of data from the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry. Circulation. 2011, 123(25): 2975-2984.
3. Weinstein S, Bello R, Pizarro C, et al. The use of the Berlin Heart EXCOR in patients with functional single ventricle. J Thorac Cardiovasc Surg. 2014, 147(2): 697-705.
4. Joshua MF, Jennifer C, Hirsch R, et al. Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation. J Thorac Cardiovasc Surg. 2014, 148(1): 266-272.
5. Allan CK, Thiagarajan RR, del Nido PJ, et al. Indication of initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrance oxygenation. J Thorac Cardiovasc Surg. 2007, 133(3): 660-667.
6. Ravishankar, C, Dominguez, TE, Kreutzer J, et al. Extracorporeal membrane oxygenation after stage I reconstruc- tion for hypoplastic left heart syndrome. Pediatr Crit Care Med. 2006, 7(4): 319-323.
7. Elizabeth DS, Kimberlee G, Mark AS, et al. Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2012, 144(6): 1337-43. 4.
8. Sarah T, Nancy G, Chitra R, et al. Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg. 2012, 144(4): 882-895.
9. Debrunner MG , Porayette P , Breinholt JP , et al. Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation. Pediatr Cardiol. 2013, 34(3): 570-575.
10. Alsoufi B , Wolf M , Botha P, et al. Late outcomes of infants supported by extracorporeal membrane oxygenation following the Norwood operation. World J Pediatr Congenit Heart Surg. 2015, 6(1): 9-17.
11. De Rita F, Hasan A, Haynes S, et al. Mechanical cardiac support in children with congenital heart disease with intention to bridge to heart transplantation. Eur J Cardiothorac Surg. 2014, 46(4): 656-662.
12. Durham LA, Dearani JA, Burkhart HM, et al. Application of computer modeling in systemic VAD support of failing Fontan physiology. World J Pediatr Congenit Heart Surg. 2011, 2(2): 243-248.