目的 比较开窗与不开窗对改良Fontan术早期疗效的影响.方法 回顾性分析2008年11月至2013年6月在阜外心血管病医院行改良Fontan术的90例复杂先天性心脏病患者的围手术期临床资料.按照术中是否行板障开窗术,将患者分为开窗组(49例)和未开窗组(41例),并比较两组的早期疗效.结果 两组的年龄、性别、体质量和疾病类型差异均无统计学意义(P均>0.05).术后中心静脉压开窗组为(11.4±4.1)mmHg(1 mmHg =0.133 kPa),未开窗组为(12.1±3.8) mmHg(P =0.894);胸腔引流管留置时间开窗组为(11.1±9.2)d,未开窗组为(15.0±10.7)d(P=0.160);胸腔引流液量开窗组为772.0(411.5~1 971.5) ml,未开窗组为1 259.0(571.0 ~2 647.5)ml(P =0.214);重症监护室住院时间开窗组为24.0(18.0~40.0)d,未开窗组为24.0(19.0 ~36.0)d (P=0.751);呼吸机使用时间开窗组为9.0(6.0~15.0)h,未开窗组为8.0(6.0~16.0) h(P=0.951);总住院时间开窗组为(32.7 ±23.0)d,未开窗组为(27.8±12.6) d(P=0.025);1例(2.0%)开窗组患者术后在住院期间出现低心排综合征后死亡,1例(2.4%)未开窗组患者术后出现心包积液,两组之间的并发症比例(P =0.898)和病死率(P=1.000)差异均无统计学意义.结论 与不开窗比较,开窗不能明显提高改良Fontan术的早期疗效.
Objective To compare the impact of fenestration on early outcome in patients undergoing modified Fontan operation.Methods Data from 90 consecutive patients underwent modified Fontan operation from November 2008 to June 2013 were retrospectively analyzed.Patients were divided into fenestrated group (49 patients) and non-fenestrated group (41 patients) and early outcome post operation was compared between the two groups.Results Anatomy,age,gender,body weight and disease classifications were similar between the two groups (all P > 0.05).Postoperative central venous pressure was (11.4 ±4.1) mmHg (1 mmHg =0.133 kPa)in fenestrated group and (12.1 ±3.8) mmHg in nonfenestrated group(P =0.894).The duration of chest tube drainage was (11.1 ± 9.2) day in fenestrated group and(15.0 ± 10.7) day in non-fenestrated group(P =0.160).Volume of pleural drainage was 772.0 (411.5-1 971.5) ml in fenestrated group and 1 259.0(571.0-2 647.5) ml in non-fenestrated group (P =0.214).Duration of ICU stay was 24.0 (18.0-40.0) day in fenestrated group and 24.0 (19.0-36.0) day in non-fenestrated group(P =0.751).The time of respirator use was 9.0(6.0-15.0) hours in fenestrated group and 8.0 (6.0-16.0) hours in non-fenestrated group (P =0.951).Duration of hospital stay was significantly longer in fenestrated group than in non-fenestrated group ((32.7 ± 23.0) day vs.(27.8 ± 12.6) day,P =0.025).One patient (2.0%) died of low cardiac output syndrome in fenestrated group and 1 patient (2.4%) experienced hydropericardium in non-fenestrated group.The incidence rate of complications (P =0.898) and mortality (P =1.000) were similar between the two groups.Conclusion Early outcome is similar for patients undergoing the modified Fontan operation with or without fenestration.