ALCAPA术后心功能支持及早期预后

Zhihao Li, Jiming Cai, Zhuoming Xu, Haibo Zhang, Jinghao Zheng
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摘要

目的总结左冠状动脉异常起源肺动脉手术后的心功能特点及支持方法。分析其早期结局及死亡危险因素。方法回顾2005年1月至2017年12月上海儿童中心收治的108例ALCAPA患儿的临床资料。所有病例根据患者接受手术时的年龄分为两组:11岁组。采用左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD) Z-score作为描述术后心功能变化的参数。总结血管活性药物的选择和应用及其术后评分(VIS),间接反映术后心功能。分析机械循环支持的启动和终止时机及机械通风疏散时间。采用logistic分析方法寻找ALCAPA术后早期死亡的危险因素。结果alcapa术后早期心功能无明显改善,术后第5天未达到正常范围,LVEF 1组为0.42,2组为0.45。血管活性药物的应用倾向于选择α, β受体激动剂,其中肾上腺素和去甲肾上腺素是首选,早期VIS评分较高。18例采用机械循环支架。本组死亡12例,死亡率11%。Logistic回归分析提示术前低年龄和低水平LVEF是导致死亡的危险因素。结论ALCAPA术后早期心功能仍处于较低水平,需加大血管活性药物的剂量,必要时需给予机械循环支持。我们建议脱离机械循环支持和机械通气的LVEF指数分别大于0.40和0.35,同时考虑其他临床症状。术前低年龄和低LVEF水平是ALCAPA术后早期死亡的危险因素。关键词:先天性心脏病;ALCAPA;作用于血管的药物;机械循环支架
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Cardiac function support after ALCAPA operation and its early outcome
Objective To summarize cardiac function feature and its support method after ALCAPA(anomalous origin of left coronary arteries from pulmonary artery) operation. Analysis its early outcome and risk factors of its mortality. Methods Review the clinical data of 108 ALCAPA cases treated in Shanghai Children Center between January 2005 and December 2017. All the cases were divided into two groups according to their ages when they received the surgery: group 1 1yr. Adopted LVEF(left ventricle ejection fraction) and LVEDD(left ventricle end-diastolic diameter) Z-score as a parameter to describe the cardiac function change after operation. Summarize the selection and application of vasoactive agents and its score(VIS) after operation, indirectly reflect the post-operative cardiac function. Analysis the opportunityofinitiation and termination of mechanical circulation support and the timefor mechanical ventilationevacuation. Adopt the logistic analysis to find the risk factors of early death risk factors after ALCAPA operation. Results Cardiac function had little improve in early period after ALCAPAoperation, did not attained normal range in fifth day post-operative, LVEF was 0.42 in group 1 and 0.45 in group 2, respectively. The application of vasoactive agents tended to choose α, β receptor-agonist, which epinephrine and norepinephrine is the preferred and VIS score was high in early period. Mechanical circulation support was used in 18 cases. 12 cases died in our group, mortality was 11%. Logistic regression analysis implied that low age and low level of LVEF before operation is the risk factor for mortality. Conclusion Cardiac function was still in low level in early period after ALCAPA operation, depended on higher dosage of vasoactive agents and mechanical circulation support if necessary. We recommend the LVEF index for evacuated from mechanical circulation support and mechanical ventilation is over 0.40 and 0.35 respectively, and other clinical sign should be considered simultaneously. Low age and low LVEF level before operation is the risk factors for early death after ALCAPA operation. Key words: Congenital heart disease; ALCAPA; Vasoactive agents; Mechanical circulation support
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