成人ＴＯＦ的手术治疗特点(2)
术后处理的重点仍是保证血液动力学的稳定。成人往往需要较多的容量，补充的容量要足够，以达到其最佳血液动力学的上限。术后1～3天，应根据引流量全量补充全血和胶体，以后可逐渐增加晶体液量，适时利尿，保证足够的尿量，利尿药物可以小剂量甘露醇为首选，能避免血容量过度下降，维持血管张力，也有降低血液粘滞度的作用。呼吸机应用可减轻心脏负荷，以利左、右心功能的调整及恢复，且对体外循环造成的肺损伤有治疗作用。另外，由于手术前后患者对低氧血症耐受较好，术后其呼吸中枢对低氧血症反应不敏感，代偿作用不显著，如过早脱离呼吸机后，易导致高碳酸血症、乳酸血症，严重的会因此需要再次气管插管行呼吸机冶疗。所以，此类患者只有当血液动力学的稳定，血气指标正常，胸部X片正常，患者神智、肌力正常方可依照脱机程序脱离呼吸机。
目前认为，只要病人不出现终未期器官功能衰竭的状态，成人TOF应积极地进行手术治疗。正确认识成人TOF的病理解剖及病理生理学特点，采用现代各项新技术，可降低手术死亡率，减少并发症。
参考文献
1 Pozzi M, Trivedi DB, Kitchiner D, et al. Tetralogy of Fallot: what operation, at which age.Eur. J. Cardiothorac. Surg., 2000; 17(1): 631 – 636.
2 来永强,肖巍,白涛,等.成人法洛四联症的外科治疗 .中华胸心血管外科杂志,2004,20(5)：274-276.
3 Faidutti B, Christenson JT, Beghetti M,et al. How to diminish reoperation rates after initial repair of tetralogy of Fallot?.Ann. Thorac. Surg., 2002; 73(1): 96 - 101.
4 Y. d'Udekem d'Acoz, A. Pasquet, L. Lebreux, C. Ovaert, F. Mascart, A. Robert, and J. E. Rubay.Does right ventricular outflow tract damage play a role in the genesis of late right ventricular dilatation after tetralogy of Fallot repair?.Ann. Thorac. Surg., 2003; 76(2): 555 - 561.
5 Giannopoulos NM, Chatzis AK, Karros P,et al. Early results after transatrial/transpulmonary repair of tetralogy of Fallot Eur. J. Cardiothorac. Surg., 2002; 22(4): 582 - 586.
6 Koshy S, Sumangala SG, Radha AS,et al. Tricuspid Valve Detachment for Transatrial Closure of Ventricular Septal Defects.Asian Cardiovasc Thorac Ann, 2002; 10(12): 314 - 317.
7 Toru Ishizaka, Hajime Ichikawa, Yoshiki Sawa, Norihide Fukushima, Koji Kagisaki, Haruhiko Kondo, Shigetoyo Kogaki, and Hikaru Matsuda Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot.Eur. J. Cardiothorac. Surg., 2004; 26(6): 1080 - 1086.
[ 上 页 ], 百拇医药(闪 辉)
目前认为，只要病人不出现终未期器官功能衰竭的状态，成人TOF应积极地进行手术治疗。正确认识成人TOF的病理解剖及病理生理学特点，采用现代各项新技术，可降低手术死亡率，减少并发症。
参考文献
1 Pozzi M, Trivedi DB, Kitchiner D, et al. Tetralogy of Fallot: what operation, at which age.Eur. J. Cardiothorac. Surg., 2000; 17(1): 631 – 636.
2 来永强,肖巍,白涛,等.成人法洛四联症的外科治疗 .中华胸心血管外科杂志,2004,20(5)：274-276.
3 Faidutti B, Christenson JT, Beghetti M,et al. How to diminish reoperation rates after initial repair of tetralogy of Fallot?.Ann. Thorac. Surg., 2002; 73(1): 96 - 101.
4 Y. d'Udekem d'Acoz, A. Pasquet, L. Lebreux, C. Ovaert, F. Mascart, A. Robert, and J. E. Rubay.Does right ventricular outflow tract damage play a role in the genesis of late right ventricular dilatation after tetralogy of Fallot repair?.Ann. Thorac. Surg., 2003; 76(2): 555 - 561.
5 Giannopoulos NM, Chatzis AK, Karros P,et al. Early results after transatrial/transpulmonary repair of tetralogy of Fallot Eur. J. Cardiothorac. Surg., 2002; 22(4): 582 - 586.
6 Koshy S, Sumangala SG, Radha AS,et al. Tricuspid Valve Detachment for Transatrial Closure of Ventricular Septal Defects.Asian Cardiovasc Thorac Ann, 2002; 10(12): 314 - 317.
7 Toru Ishizaka, Hajime Ichikawa, Yoshiki Sawa, Norihide Fukushima, Koji Kagisaki, Haruhiko Kondo, Shigetoyo Kogaki, and Hikaru Matsuda Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot.Eur. J. Cardiothorac. Surg., 2004; 26(6): 1080 - 1086.
[ 上 页 ], 百拇医药(闪 辉)