• 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院?阜外心血管病醫(yī)院?小兒心臟外科中心， 北京?100037;

目的　分析腔靜脈-肺動(dòng)脈連接術(shù)后圍術(shù)期血栓栓塞的表現(xiàn)、治療、轉(zhuǎn)歸和可能危險(xiǎn)因素，評(píng)估預(yù)防血栓栓塞措施的效果?！》椒ā』仡櫺苑治?005年9月至2010年12月期間阜外心血管病醫(yī)院完成雙向Glenn手術(shù)264例、全腔靜脈-肺動(dòng)脈連接術(shù)（total cavopulmonary connection，TCPC） 224例患者的臨床資料，其中圍術(shù)期發(fā)生血栓栓塞9例，男5例，女4例；年齡0.9～11.0 （5.1±3.7）歲；體重8～30 （17±8） kg 。5例為雙向Glenn手術(shù)，4例為TCPC。多數(shù)栓塞患者合并至少一個(gè)血栓高危因素。術(shù)后常規(guī)靜脈泵入預(yù)防量肝素10 U/?（kg·h），續(xù)以口服阿司匹林1～3 mg/?（kg·d）預(yù)防血栓。　結(jié)果　9例中 6例血栓栓塞發(fā)生于術(shù)后7 d之內(nèi)，3例發(fā)生在術(shù)后2～4周。9例均給予肝素抗凝治療，其中1例行下腔靜脈-右心房連接術(shù)。死亡3例（33%），分別占同期雙向Glenn手術(shù)和TCPC 后早期死亡的33% （1/3） 和18% （2/11）；其余6例癥狀和體征改善或消失?！〗Y(jié)論　腔靜脈-肺動(dòng)脈連接術(shù)后圍術(shù)期血栓栓塞的病死率高，是此類手術(shù)術(shù)后早期死亡的重要原因。圍術(shù)期預(yù)防血栓的策略有效，但仍需注意避免一些相關(guān)危險(xiǎn)因素。

引用本文： 凌雁,郭少先,沈向東,閆軍,李守軍. 腔靜脈-肺動(dòng)脈連接術(shù)后圍術(shù)期血栓栓塞的治療與預(yù)防. 中國胸心血管外科臨床雜志, 2012, 19(4): 358-361. doi: 復(fù)制

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1. occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
2. 　Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
3. 　Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
4. 　Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
5. 　Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
6. 　Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
7. 　Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
8. 　Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
9. 　Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
10. 　Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
11. 　Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
12. 　Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
13. 　Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
14. 　d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
15. 　Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
16. 　Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
17. 　Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
18. 　Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
19. 　Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
20. 　Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
21. 　Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
22. 　Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.
  1. 1. occluded cavopulmonary connections in infants and children. Interact Cardiovasc Thorac Surg, 2010, 10 （3）：383-388.
  2. 2. 　Hedrick M, Elkins RC, Knott-Craig CJ, et al. Successful thrombectomy for thrombosis of the right side of the heart after the Fontan operation. Report of two cases and review of the literature. J Thorac Cardiovasc Surg, 1993, 105 （2）：297-301.
  3. 3. 　Jahangiri M, Shore D, Kakkar V, et al. Coagulation factor abnormalities after the Fontan procedure and its modifications. J Thorac Cardiovasc Surg, 1997, 113 （6）：989-992.
  4. 4. 　Shirai LK, Rosenthal DN, Reitz BA, et al. Arrhythmias and thromboembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg, 1998, 115 （3）：499-505.
  5. 5. 　Monagle P, Cochrane A, McCrindle, et al. Thromboembolic complications after Fontan procedures-the role of prophylactic anticoagulation. J Thorac Cardiovasc Surg, 1998, 115 （3）：493-498.
  6. 6. 　Coon PD, Rychik J, Novello RT, et al. Thrombus formation after the Fontan operation. Ann Thorac Surg, 2001, 71 （6）：1990-1994.
  7. 7. 　Ravn HB, Hjortdal VE, Stenbog EV, et al. Increased platelet reactivity and significant changes in coagulation markers after cavopulmonary connection. Heart, 2001, 85 （1）：61-65.
  8. 8. 　Jacobs ML, Pourmoghadam KK, Geary EM, et al. Fontan’s operation： is aspirin enough? Is coumadin too much? Ann Thorac Surg, 2002, 73 （1）：64-68.
  9. 9. 　Odegard KC, McGowan FX, Zurakowski D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure：　increased factor VIII may predispose to thrombosis. J Thorac　Cardiovasc Surg, 2003, 125 （6）：1260-1267.
  10. 10. 　Gupta A, Daggett C, Behera S, et al. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac　Cardiovasc Surg, 2004, 127 （6）：1664-1669.
  11. 11. 　Van den Bosch AE, Roos-Hesselink JW, Van Domberg, et al. Long-term outcome and quality of life in adult patients after the Fontan operation. Am J Cardiol, 2004, 93 （9）：1141-1145.
  12. 12. 　Kaulitz R, Ziemer G, Rauch R, et al. Prophylaxis of thromboembolic complications after the Fontan operation （total cavopulmonary anastomosis）. J Thorac Cardiovasc Surg, 2005, 129 （3）：569-575.
  13. 13. 　Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome 30 years of experience in 142 patients. J Am Coll Cardiol, 2006, 48 （11）：2301-2305.
  14. 14. 　d’Udekem Y, Iyengar AJ, Cochrane AD, et al. the Fontan procedure：　contemporary techniques have improved long-term outcomes.　Circulation, 2007, 116 （suppl 1）：I157-I164.
  15. 15. 　Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117 （1）：85-92.
  16. 16. 　Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg, 2008, 33 （4）：626-632.
  17. 17. 　Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the　diagnosis and management of acute pulmonary embolism. Eur Heart J, 2008, 29 （18）：2276-2315.
  18. 18. 　Tapson VF. Acute pulmonary embolism. N Engl J Med, 2008, 358 （10）：1037-1052.
  19. 19. 　Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy in　neonates and children. American college of chest physicians evidence-based clinical practice guidelines （8th edition）. Chest, 2008, 133 （6）：887S-968S.
  20. 20. 　Sreeram N, Emmel M, Trieschmann U, et al. Reopening acutely.
  21. 21. 　Massicotte P, Julian JA, Gent M, et al. An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children： the PROTEKT trial. Thromb Res, 2003, 109 （2-3）：101-108.
  22. 22. 　Hanslik A, Thom K, Haumer M, et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the　upper venous system. Pediatrics, 2008, 122 （6）：1284-1291.