血红蛋白200g/L以上紫绀型先天性心脏病患者手术效果分析

目的:明确血红蛋白200 g/L以上紫绀型先天性心脏病患者的手术效果。方法:选取2009年3月至2012年3月于我中心就诊手术治疗的紫绀型先天性心脏病患者,按血红蛋白计数≥200 g/L和200 g/L分为A组和B组,完善术前检查后进行手术治疗。记录患者手术效果和随访情况;观察比较两组患者手术中情况包括:手术方式、手术时间、体外循环时间、心脏停搏时间、心脏自动复跳情况;记录并比较两组患者手术后恢复情况,包括机械通气时间、监护室滞留时间、手术后24小时内出血量、二次开胸止血例数和血管活性药物评分,以及监护室内肝肾功能异常和肺部并发症发生例数。结果:A组死亡3例(5.2%),23例术后3个月随访效果良好;B组死亡2例(5.8%),12例术后3个月随访效果良好。两组患者手术方式、手术时间、体外循环时间和心脏停搏时间、自动复跳例数均无明显差异(P0.05)。与B组比较,A组患者术后机械通气和监护室滞留时间长,术后24小时出血量多,血管活性药物使用评分高,肝肾功能异常例数和肺部并发症发生例数较多有统计学意义(P0.05),两组间二次开胸止血例数无统计学差异(P0.05)。结论:血红蛋白200 g/L以上紫绀型先天性心脏病患者与其他紫绀型先天性心脏病患者手术效果相似,但手术后恢复慢,并发症较多。

Operative Effects of Patients with Hemoglobin above 200 g/Lin Cyanotic Congenital Heart Disease

Objective： To investigate operative effects of patients with hemoglobin above 200 g/L in cyanotic congenital heart disease. Methods： From March 2009 through March 2012, patients with cyanotic congenital heart disease scheduled for operation were grouped as A group （57 cases） and B group （34 cases） according to hemoglobin-〉 200 g/L or not, and operation performed after preopera tive examinations. Operative effects and follow up examinations in the two groups were observed. The records from two groups were compared in terms of operative style and operating time, cardiopulmonary bypass time, cardiac arrest time, automatic cardioversion in operation. The records of recovery from two groups were compared included ICU time, ventilation time, blood loss in first 24h after operation, cases of second operation for bleeding, inotropic scores, liver and kidney dysfunction and pulmonary complications in ICU. Results： Three patients died in group A, and 23 cases had contented follow-up examinations 3 months later. Death accurred to 2 cases in group B and 12 cases had satisfactory follow-up 3 months later. There was no statistical difference between the two groups as to operative style, operating time, cardiopulmonary bypass time, cardiac arrest time and automatic cardioversion in operation （P 〉0.05 ）. Compared with group B, patients in group A had longer ICU time and ventilation time, more blood loss, higher inotropic scores, higher frequency of liver and kidney dysfunction and pulmonary complications in ICU （P〈0.05）. There was no statistical difference between the two groups in cases of second operation for bleeding. Conclusion： Patients with hemoglobin above 200 g/L posses a similar operative effects to other patients with cyanotic congenital heart disease, but have longer recovery and more complications after operation.