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??Objective To investigate the effect and safety of single dose of dezocine for anesthesia in children with cyanotic complex congenital heart disease on cardiac catheterization??and compare it with ketamine. Methods Sixty-four children with cyanotic complex congenital heart disease undergoing cardiac catheterization??under 6 years old?? between January 2014 and April 2015 in the First Hospital of Tsinghua University were randomly divided into intravenous dezocine??0.2 mg/kg?? group ??group D??n = 32?? and intravenous ketamine??2.0 mg/kg?? group ??group L??n = 32?? as soon as arriving at OR. All patients were inserted the laryngeal mask??LMA??after the same intravenous induction and the initial end-tidal concentration of sevoflurane was 2.0% to 2.5%. The time to lose consciousness??T1????mask assisted ventilation time??T2????anesthesia recovery time??T3????and such adverse reactions as airway spasm??respiratory depression??dysphoria??pain??nausea and vomiting were recorded. Results T1 of group D was significantly longer than that of group L??P??0.05??. T3 of group D was significantly shorter than that of group L??P??0.05??. The cases whose drop of SPO2 during induction and after extubation was greater than 20% and who needed suction more than twice in group D were fewer than in group L??P??0.05??. Conclusion Single dose dezocine of 0.2 mg/kg can be safely used in children with cyanotic complex congenital heart disease on cardiac catheterization??providing satisfactory sedation and analgesia??and the incidence of airway adverse reaction is lower than that of ketamine.     

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目的探讨儿童感染性心内膜炎(IE)的临床特点、治疗方法及转归。方法回顾分析中南大学湘雅二医院儿科1980—2004年确诊的174例IE患儿的临床特点。174例患儿中男94例,女80例,年龄3个月至14岁,病程3d至4个月。结果(1)99例IE发生在先天性心脏病的基础上,35例发生在风湿性心脏病的基础上,35例发生在无器质性心脏病基础上,4例于先天性心脏病手术后发生,1例发生在肥厚性心肌病的小儿。(2)临床主要表现:发热(150例,86·2%)、肝大(74例,42·5%)、脾大(55例,31·6%)、贫血(65例,37·4%)、血沉增快(68例,39·1%)、多发性脏器栓塞(34例,17·8%)。细菌培养76例(76/174)阳性,阳性率43·7%,其中55例为葡萄球菌。(3)受累瓣膜以二尖瓣赘生物最多见,占48·3%。(4)并发症以顽固性心衰为主(25·2%),其次为神经系统并发症(13·2%),瓣膜腱索断裂最少见(0·57%)。(5)由于IE临床表现很不典型,病例早期被误诊为流感、肺结核、急性风湿热、肾小球肾炎等10余种疾病。(6)治愈率为60·9%,其中单用抗生素治疗治愈76例(71·6%),抗感染治疗联合外科手术治愈30例(28·3%)。死亡28例(16·1%),脑栓塞及顽固性心衰是IE最常见的死亡原因。结论发生IE的基础心脏病中,先天性心脏病跃居首位,风湿性心脏病逐渐减少。血培养、超声心动图检查有助于IE的诊断。对于IE最重要的治疗措施是应用抗生素,若经内科治疗效果不满意应尽早考虑外科治疗。     

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??Objective??To explore the effects and results of temporary cardiac pacing in children with bradyarrhythmia. Methods??The clinical data of 55 children with bradyarrhythmia who received temporary cardiac pacing between June 2007 and May 2018 in Children’s Hospital of Chongqing Medical University were analyzed retrospectively. The clinical characteristics and curative effects were summarized and statistically analyzed. Results??A total of 55 cases of bradyarrhythmia included 29 cases of severe atrioventricular block??AVB????sinus bradycardia or cardiac arrest caused by myocarditis??5 cases of ??°AVB or sick sinus syndrome caused by cardiomyopathy??6 cases of ??°AVB caused by congenital heart disease after surgery??5 cases of congenital ??°AVB??and 10 cases of perioperative temporary pacing ??°AVB. Among them??39 cases were compared in Adams-Stokes syndrome??P??0.003????34 cases were compared in ejection fraction and fractional shortening??P??0.000??P??0.001????and 26 patients were compared in left ventricular end diastolic diameter??P??0.001?? before and after temporary pacing??and there were statistically differences. After treatment??18 cases were clinically cured??36 cases were improved??and 1 case died??among which 45% arrhythmia were improved or recovered??and 10 cases of perioperative children all passed through the anesthesia period. Kruskal-Wallis H(K?? test showed that the clinical and arrhythmia prognosis of different basic cardiovascular diseases were not completely the same??P??0.001??P??0.000???? Mann-Whitney U test indicated a better prognosis in the myocarditis group??P??0.001??P??0.000??. Conclusion??Temporary cardiac pacing can effectively relieve the clinical symptoms of severe bradyarrhythmia caused by various etiologies??promote the recovery of acute conduction system injury??and reduce ??°AVB perioperative risk. Temporary cardiac pacing is a safe and effective prevention and first-aid technique.     

Neurologic and cognitive outcomes in children with congenital heart disease.

Advances in congenital heart surgery have resulted in the increased survival of infants born with complex congenital heart disease. Questions remain, however, about how these patients will develop and whether they will have normal, productive lives. To date, studies have shown that although the vast majority of children with congenital heart disease have normal outcomes, as a group they generally have higher rates of neurodevelopmental problems. The developmental sequelae include mild problems in cognition, attention, and neuromotor functioning. The etiology of neurologic deficits in this population appears to be multifactorial with preoperative, operative, and postoperative factors all contributing to outcome. Continued research and attempts to minimize neurologic injury and associated sequelae are of primary importance. Recent data suggest that advances in care already may be improving outcome after congenital heart surgery. Ongoing documentation of the long-term outcome in this population needs to be mandated, as does the implementation of environmental enrichment programs to help ameliorate the long-term consequences of congenital heart disease.     

吲哚胺2,3-双加氧酶作为小儿先天性心脏病术后全身炎症反应综合征诊断标志物的价值

目的 探讨吲哚胺2,3-双加氧酶（IDO）作为小儿先天性心脏病（简称先心病）体外循环术后全身炎性反应综合征（SIRS）早期诊断标志物的价值。方法 选取2012年5月至2016年1月行体外循环手术的先心病患儿90例,按照术后是否发生SIRS分为SIRS组（n=43）和对照组（未发生SIRS,n=47）。收集患儿术前、术中、术后不同时间点外周血,测定并比较两组血清IDO、白细胞介素-6（IL-6）、C-反应蛋白（CRP）浓度。利用ROC曲线分析各指标的诊断效能。结果 SIRS组血清CRP水平在术后72 h,IL-6水平在转机中及术后72 h高于对照组;血清IDO水平在术后24 h及72 h高于对照组。IDO在术后24 h对SIRS有诊断意义,其ROC曲线下面积为0.793,特异性为100%,敏感性为58.14%。CRP、IL-6及IDO在术后72 h对SIRS均有诊断意义,其中IDO诊断效能最高,其ROC曲线下面积为0.927,特异性为95.74%,敏感性为76.74%。结论 小儿先心病术后IL-6、CRP及IDO对诊断SIRS均有一定意义,其中IDO诊断效能最高,可更早、更准确预测小儿先心病术后SIRS的发生。     

Neurologic sequelae of cardiac surgery in children

Major advances in surgical and cardiopulmonary bypass technology have occurred in the past 30 years. Total correction of previously inoperable congenital cardiac defects is being performed with increasing frequency and in children at progressively younger ages. While the majority of children undergoing cardiac surgery survive without incident, increasing concern is being raised about neurologic sequelae seen in some survivors. Complications such as embolization, hypoxia, inadequate cerebral perfusion, and biochemical disturbances may all lead to brain damage following cardiac surgery. Acute postoperative neurologic problems include seizures, impaired levels of consciousness, focal motor deficits, and movement disorders. Long-term sequelae include language and learning disorders, mental retardation, seizures, and cerebral palsy. Intraoperative cerebral monitoring techniques are as yet imperfect, but their use in combination with meticulous intraoperative and postoperative care currently provides the best means of reducing neurologic morbidity. Future studies should explore other methods of preserving neurologic integrity in children undergoing open heart surgery.     

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目的 分析心血管造影(ACG)对不同类型先天性心脏病(CHD)分层诊断的临床意义.方法 2006年2月至2008年5月安徽省立儿童医院心内科收治的经临床、X线胸片、心电图(EKG)、超声心动图(ECHO)检查证实的各种CHD患儿34例,对比分析其ACG及ECHO检查结果 .结果 经手术证实的21例患儿中,ECHO及ACG与手术证实的完全符合率分别为71.43%(15/21)和100%(21/21),经χ<'2>检验,P<0.01.结论 ACG能满足不同类型CHD诊断和治疗的需求,且明显优于ECHO,具有不可替代的分层诊断的临床价值.     

Cerebral infarction complicating Fontan surgery for cyanotic congenital heart disease

Summary We report on four children who had cerebral vascular events in the first three months after the Fontan procedure for complex cyanotic congenital heart disease. Potential risk factors in these children included congestive heart failure, postoperative thrombocytosis, and cardiac arrhythmias. These cases suggest that children who undergo Fontan surgery may be at increased risk for cerebral infarction. Presented at the 36th Annual meeting of the American Academy of Neurology, Boston, Massachusetts, 1984.     

Neonates with congenital heart disease

Early reparative surgery in neonates and infants with congenital heart disease, as opposed to initial palliation and later repair, is now commonplace. Changes to the conduct of cardiopulmonary bypass, timing of surgery and surgical techniques, and perioperative management substantially have reduced the postoperative mortality and morbidity for these patients. The success of this strategy of early reparative surgery now has been extended to the premature and low-birth-weight newborn, and, along with this, new challenges to postoperative care in the intensive care unit. However, the low mortality associated with two-ventricle repairs has not been the experience in newborns undergoing palliation for single-ventricle defects, in particular, hypoplastic left heart syndrome. A number of articles regarding management of newborns with single-ventricle defects have been published during the past 12 months, ranging from classification, prenatal diagnosis, treatment options, and predictors of both early and late outcome, which may provide a guide for patient management. As mortality has declined, there has been an increased emphasis on identifying indices that may predict outcome or morbidity both before and after surgery, along with possible strategies to attenuate adverse clinical responses. The inflammatory response to bypass is heightened in neonates and infants, and several reports have addressed possible techniques for attenuating the response. In addition, reports regarding the risk for necrotizing enterocolitis, the utility of lactate as an index of systemic perfusion, potential markers of myocardial and neurologic injury, and the use of mechanical support of the circulation in newborns with congenital heart disease are summarized.     

婴幼儿先心病术后并发纵膈气肿临床分析

目的探讨婴幼儿先心病术后合并纵隔气肿的常见病因、诊断和治疗方法。方法回顾性分析作者于2011年1月至2012年2月收治的9例婴幼儿心内直视手术后并发纵隔气肿患儿临床资料。结果本组患儿中5例痊愈,3例治疗效果欠佳,不能维持循环功能,家属放弃治疗,1例因严重感染未得到有效控制而死亡。结论 小儿先心病术后合并纵隔气肿,对心肺功能影响大,并可并发纵膈感染,临床表现多样,易发生误诊或漏诊,死亡率高,如能早期诊断,及时治疗,效果良好。