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混合与诺伍德策略对单心室息的策略
Kenji Baba1, Yasuhiro Kotani, Devin Chetan
1Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Circulation
|September 12, 2012
概括
对于混合和诺伍德策略来说,第二阶段息后的生存率相似. 混合方法显示了更高的肺动脉再干预率和更小的肺动脉大小,需要精细化以实现最佳生长.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 生产性心脏手术 手术 生产心脏手术
- 单心室生理学 单心室生理学
背景情况:
- 诺伍德和混合策略代表了对具有功能单心室生理学的新生儿的第二阶段息程序的不同方法.
- 这些策略之间存在显著差异,需要进行比较分析.
研究的目的:
- 为了比较混合和诺伍德策略的第二阶段缓和治疗.
- 为了评估在II阶段缓和和随后的Fontan完成后的生存率和再干预率.
- 在这个患者群体中确定重新干预的预测因素.
主要方法:
- 追溯研究75名新生儿在初始I期息后接受II期息 (诺伍德,n=43;混合,n=32).
- 组间的生存率,再干预率,Fontan前的解剖学/生理学变量和Fontan结果的比较.
- 对重新干预的预测因素的分析.
主要成果:
- 在第二阶段息后3年生存率相当于 (诺伍德: 80.4%,混合: 85.6%).
- 混合患者经历了更高的肺动脉再干预率和更低的纳卡塔指数前Fontan.
- 在Fontan完成后,在任何一组中都没有死亡.
结论:
- 混合和诺伍德策略都在第二阶段缓和和Fontan完成后产生相当的生存率.
- 混合策略与肺动脉再干预的增加和肺动脉尺寸的缩小有关,这表明需要优化.
- 这两种方法都为Fontan完成建立了足够的生理学,但建议对Hybrid策略进行改进,以改善肺动脉发展.
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