目的 探讨大动脉调转术(ASO)治疗完全性大动脉转位(TGA)患儿的临床疗效及影响预后的可能因素.方法 选取2006年6月至2012年12月在本院接受ASO手术治疗的TGA患儿156例作为研究对象,观察所有患儿的临床疗效及预后,并结合临床资料分析其与预后结局的关系.结果 156例TGA患儿均顺利完成手术,5年随访期间死亡29例,死亡率为18.59％.单因素分析显示TGA患儿ASO术后死亡与冠状动脉异常、体外循环时间、主动脉阻断时间、术后低心排综合征、再次手术治疗有关(P＜0.05),多因素Logistic回归分析显示冠状动脉异常、低心排综合征是导致患者术后死亡的独立危险因素.结论 TGA患儿ASO术后死亡与患儿术前合并冠状动脉异常、术中体外循环时间、主动脉阻断时间过长及术后低心排综合征的发生密切相关,临床应予以重视并采取相关对策.%Objective To investigate the clinical efficacy and influencing factors of arterial switch operation (ASO) in the treatment of complete transposition of great arteries (TGA).Methods Totally 156 children with TGA who underwent ASO surgery from January 2005 to December 2011 were selected as the subjects.The clinical curative effect and prognosis of all patients were observed,and the relationship be tween clinical features and prognosis was analyzed.Results Totally 156 cases of TGA children were successfully completed the operation,and 29 patients died during the 5 year follow-up period,the mortality rate was 18.59％.Univariate analysis showed that the death in children with TGA after ASO was closely related to coronary artery abnormality,cardiopulmonary bypass time,aortic occlusion time,postoperative low cardiac output syndrome and reoperation (P ＜ 0.05).Multivariate logistic regression analysis showed that coronary artery abnormalities,and low cardiac output syndrome were independent outcome factors leading to postoperative death in patients.Conclusions The postoperative death of ASO in TGA children is closely related to the incidence of coronary artery abnormalities,the time of cardiopulmonary bypass,the time of oc clusion of aorta and the occurrence of postoperative low cardiac output syndrome,which should be pay attention to and take relevant measures.
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