婴幼儿法洛四联症矫治术后毛细血管渗透症的诊断与治疗

目的:探讨婴幼儿法洛四联症(tetralogy of Fallot,TOF)矫治术后,毛细血管渗透症发病机制、诊断及处理。方法:我院2005年3月至2010年1月施行婴幼儿TOF矫治术161例,术后并发毛细血管渗透症6例,男性4例,女性2例,年龄9~36个月,平均(8±0.6)个月;体质量8.5~15.5kg,平均(8.2±2.10)kg。全组均及时给予提高胶体渗透压、应用血管活性药、腹膜透析、呼吸机辅助维持呼吸、循环稳定和组织灌注治疗。结果:治愈5例,死亡1例,死于肾、肺、心多脏器衰竭。结论:婴幼儿心脏术后毛细血管渗透症发病机制与补体致炎性介质释放,使毛细血管通透性增加有关,低心排出量综合征(低心排)、呼吸衰竭、急性肾衰竭、脑损害是致死主要原因,及时采用腹膜透析和免疫球蛋白可获得较好疗效。

The diagnosis and treatment of postoperative capillary leak syndrome for infants with tetralogy of Fallot

Objective：To study the mechanism, diagnosis and treatment of postoperative capillary leak syndrome（CLS） for infants with tetralogy of Fallot. Methods：There are 6 cases with postoperative capillary leak syndrome in 161 infants with tetralogy of Fallot from January 2005 to August 2010. There were 4 male and 2 female ,with an age from 9 -36 months and weight from 8. 5-15.5kg. Intravennous fluid including albumin, Dopatamine,peritoneal dialysis and mechanical ventilation are given to maintain respiratory and circulation steady and tissue perfusion. Results ： There are 5 cases recovered and 1 death because of multiple organ failure. Conclusion：The mechanism of CLS in infants open heart surgery may be concerned with the capillaries endothelial damage due to the alexin activation resulting in cytokine releasing. Low cardiac output syndrome, respiratory failure, renal failure, brain damage were the most frequent cause of mortality in infants open heart surgery with CLK. That peritoneal dialysis and intravenous immunoglobulin are early given may have an excellent result in infants open heart surgery with CLS.