新生儿和婴幼儿先天性心脏病围手术期治疗的临床分析

目的 总结新生儿和婴幼儿先天性心脏病围手术期的监护及并发症处理经验.方法 回顾性分析30例病情危重,或解剖复杂的先天性心脏病新生儿、婴幼儿行外科手术治疗围手术期的临床资料,分析患儿先天性心脏病的种类,手术年龄,手术方法 ,术后各种并发症及处理方法 和治疗效果.结果 7例出现较严重并发症,占23.3%(7/30);术中16例行超声心动图监测,其中12例行食道超声监测(体质量>5 kg),4例行剑突下超声监测;所有患儿均康复出院.7例出现较严重并发症.结论 强调新生儿、婴幼儿先天性心脏病外科手术围手术期的重要性,积极监测,及时处理各种并发症是取得治疗成功的关键.     

新生儿和婴幼儿先天性心脏病围手术期治疗的临床分析

目的 总结新生儿和婴幼儿先天性心脏病围手术期的监护及并发症处理经验.方法 回顾性分析30例病情危重,或解剖复杂的先天性心脏病新生儿、婴幼儿行外科手术治疗围手术期的临床资料,分析患儿先天性心脏病的种类,手术年龄,手术方法 ,术后各种并发症及处理方法 和治疗效果.结果 7例出现较严重并发症,占23.3%(7/30);术中16例行超声心动图监测,其中12例行食道超声监测(体质量>5 kg),4例行剑突下超声监测;所有患儿均康复出院.7例出现较严重并发症.结论 强调新生儿、婴幼儿先天性心脏病外科手术围手术期的重要性,积极监测,及时处理各种并发症是取得治疗成功的关键.     

42例婴幼儿危重先天性心脏病的急诊外科治疗

目的探讨婴幼儿危重先天性心脏病急诊外科治疗的可行性、手术适应证的选择及处理原则。方法2003年5月至2006年12月为42例危重先心病婴幼儿施行急诊或亚急诊手术。结果术前准备时间1～9d,术后呼吸机辅助呼吸时间1～14(2.1±1.4)d。全组住院死亡2例,手术死亡率4.6%。随访2～24个月,心功能Ⅰ～Ⅱ级,效果满意。结论危重先天性心脏病患儿急诊、亚急诊外科治疗是安全的,可以控制大部分患儿的生命。准确选择手术适应证,正确的围术期处理是成功的关键。     

婴幼儿先天性心脏病合并气管狭窄行气管成形术的回顾性分析

目的总结婴幼儿先天性心脏病合并气管狭窄行气管成形手术的围术期麻醉管理经验。为此类患儿围术期麻醉和手术提供经验依据。方法对解放军总医院第七医学中心附属八一儿童医院心外科2008年1月至2018年6月10例先天性心脏病合并气管狭窄患儿病例回顾性分析。结果 10例患儿中1例为早产儿,9例足月儿,平均出生胎龄38.1周;同期行先天性心脏畸形矫正术和气管成形术的有3例。6例一期行先天性心脏畸形矫正术,二期行气管狭窄修复术,1例只做了气管成形术。7例采用体外循环(CPB),3例先行体外膜肺氧合(ECMO)安装后行气管成形术。术后入儿童重症监护室观察治疗,期间4例患者出现生命危险经过抢救治疗;其中3例痊愈出院,1例死亡,6例家属放弃治疗。结论婴幼儿先天性心脏病合并气管狭窄气管成形术的死亡率高,多学科团队协作密切配合能有效降低死亡率。     

10kg以下婴幼儿心内直视手术50例分析

<正> 10kg以下婴幼儿心内直视手术死亡率较高.我科自1997年6月至2000年6月,经体外循环下手术矫治先天性心脏病患儿532例.其中10kg以下婴幼儿50例,占同期先天性心脏病手术的9.4%.1 临床资料全组50例中男23例,女27例.年龄为5～24个月,平均15.5±5.7个月.1岁以下婴儿17例(34%).体重6～10Kg,平均8.7±1.1kg.1.1 室间隔缺损(VSD)     

改良Blalock-Taussig分流术在复杂先天性心脏病中的应用

目的探讨改良Blalock-Taussig分流术在复杂紫绀型先天性心脏病中的应用,评价其手术效果。方法回顾性分析2006年2～12月15例行改良Blalock-Taussig分流术的临床病例,其中男性9例,女性6例,年龄3个月至6岁,体重5.0～19.0kg。结果15例患儿均获生存,改良Blalock-Taussig分流术后患儿动脉血氧饱和度由术前的(58.7±14.1)%上升到(87.5±5.4)%,有明显改善(P<0.01)。随访3～6个月,发绀明显减轻,活动耐量增加。结论改良Blalock-Taussig分流术风险较小,对于暂时不具备根治术条件的复杂先天性心脏病的患儿,可起到挽救生命,改善缺氧,促进肺动脉发育的目的,为二期手术或根治手术创造条件。     

537例婴幼儿体外循环心内直视手术后死亡病例的年龄分布

目的 :总结 5 37例婴幼儿体外循环心内直视手术患者死亡病例的年龄分布特点及死亡原因。方法 :分析 5 37例婴幼儿先天性心脏病患儿的临床资料 ,男 336例 ,女 2 0 1例 ,年龄 1～ 36 (平均 13 2± 9 4 )个月。结果 :5 37例婴幼儿体外循环心内直视术后共死亡 36例 ,死亡率 6 7% ;其中 1999年 1月至12月的 185例患儿中死亡 8例 ,死亡率 4 3%。婴幼儿的死亡率在各年龄段的分布中以 <1岁的患儿较高 ,其中 1～ 6个月的患儿最高 (16 3% ) ;7～ 12个月的患儿死亡率 (8 1% ) ,13～ 2 4个月的患儿死亡率(6 3% ) ,2 5～ 36个月的患儿术后死亡率 (3 7% )。在死亡原因方面 ,以死于低心排综合征的婴幼儿比例最高 ,占 36例死亡婴幼儿的 5 0 % (18 36 ) ,其次是死于呼吸功能衰竭的婴幼儿占 36例死亡婴幼儿的33 3% (12 36 ) ,死于肾功能衰竭的占 11 1% (4 36 ) ,死于多脏器衰竭变竭的占 5 5 % (2 36 )。结论 :婴幼儿患者体外循环心内直视术时年龄越小死亡越高 ,死于心、肺功能衰竭的患者比例较高 ;因此对婴幼儿体外循环心脏手术时应加强术中的心脏保护效果。     

探讨婴幼儿先天性心脏病围术期肺部并发症的护理干预措施

目的对婴幼儿先天性心脏病围术期肺部并发症的护理干预措施进行分析。方法选取我院2014年1月~2015年1月收治的先天性心脏病手术患儿92例作为研究对象,将其随机分为对照组与观察组,各46例。对照组患儿围术期行常规护理干预,观察组患儿围术期行综合性护理干预,对比两组患儿并发症发生率。结果观察组患儿肺部并发症发生率为10.87%,明显低于对照组的28.26%,差异有统计学意义(P0.05)。结论对婴幼儿先天性心脏病围术期行综合性护理干预,可有效降低并发症发生率,提高效果,值得临床推广与应用。     

2046例婴幼儿期心脏病的外科治疗

目的:探讨婴幼儿期心脏病的外科治疗结果和经验。方法:对我院1990年1月至2003年12月间2046例3周岁以下婴幼儿心脏外科手术进行总结。年龄为1天～36个月(平均16.6个月),其中12个月以下784例(38.3%)。体重为1.3～15.5(平均为8.2)kg,其中≤5kg者347例(17.0%)。1796例在体外循环(CPB)下手术,其中28例在CPB过程中未阻断主动脉。250例在非CPB下手术。结果:2046例中住院死亡121例,病死率5.9%。<12个月9.3%(73/784),其中<1个月新生儿26.7%(12/45)、1～3个月15.0%(16/107)、4～6个月13.3%(26/196)、7～12个月4.4%(19/436);13～24个月3.8%(24/640);25～36个月3.8%(24/622)。结论:随着婴幼儿期手术的大量开展,对具有手术适应证患儿的先天性心脏病外科治疗时机已可不受年龄和体重限制。加强对3个月以下小婴儿,特别是新生儿期危重复杂病例的研究,可望使整体手术住院病死率进一步下降。     

分期手术治疗婴幼儿肌部多发性室间隔缺损效果分析

目的:总结探讨婴幼儿肌部多发性室间隔缺损(VSD)行分期手术的效果。方法:回顾性分析2010年1月至2018年12月北京安贞医院婴幼儿期多发性VSD患儿29例行分期手术的的临床资料,男性18,女性11例,中位年龄5(3, 6)个月,中位体质量5.7(5.2, 6.5)kg。均先行肺动脉环缩术(PAB),PAB术后平均(28.47±6.75)个月时后全部行根治手术,其中3例肌部缺损行直视封堵。同期行一期根治30例,男性14,女性16例,中位年龄12(6, 32.25)个月,中位体质量9.15(6.275, 12.725)kg。对比分析两组患儿的临床数据。结果:分期治疗组患儿无住院死亡,一期根治组患儿2例术后并发低心排综合征,其中住院死亡1例。分期手术组患儿行PAB手术时的年龄、体质量均小于一期根治组,主肺动脉/主动脉根部直径比值均大于一期根治组,差异有统计学意义。两组患儿行根治手术时术中术后及随访的临床数据差异无统计学意义。全组患儿根治手术后随访28 (7,98)个月,残余分流7例(VSD直径2 mm)。结论:对于婴幼儿期多发性VSD,应考虑先行PAB,后再行双心室根治性手术;对于肌部多发VSD可采用直视杂交封堵。     

新生儿先天性心脏病的超声心动图应用价值研究

目的 探讨新生儿先天性心脏病的超声心动图应用价值.方法 选择2005年1月-2011年1月新生儿500例,筛查新生儿先天性心脏病发病情况并进行分析.结果 本组患儿中77.5%是常见类型中的左向右分流畸形,右向左分流者占11.3%,肺动脉出口梗阻者占4.2%,左室流出道梗阻者占3.2%.结论 重视新生儿先天性心脏病的检查可早期发现先心病,以便及时治疗和预防并发症.     

人工机械瓣膜替换术103例报告

本文叙述了人工机械瓣膜替换术１０３例，施行二尖瓣替换术６４例，主动脉瓣替换术６例，三尖瓣替换术５例，主动脉及二尖瓣双瓣膜替换术２８例。置入人工机械瓣膜１３１个。术后早期死亡５例，死亡率４．９％；晚期死亡６例。对广义的心肌保护、自体输血的临床应用、术中操作、术后晚期的死亡原因及预防等一些问题谈了自己的体会。     

先心病合并重度肺动脉高压双向分流的外科对策

目的:探讨先天性心脏病伴重度肺动脉高压双向分流的外科对策及疗效。方法:回顾分析32例患者的临床资料,其中,室间隔缺损(VSD)22例,VSD合并房间隔缺损(ASD)5例,动脉导管未闭5例。术前均有不同程度劳力后紫绀,心脏B超提示双向分流,术中测量平均肺动脉压/平均体循环压>0.85,平均0.90±0.15,采用心脏停跳手术6例,不停跳手术26例。房间隔均采用自体心包片做成单向活瓣,以减轻术后早期右心负荷。结果:早期死亡3例(9.4％,3/32)。术后早期均有明显低氧血症,呼吸机支持,平均35.26±17.59小时,无气管切开病例。随访2～86(平均23.6±17.2)月,晚期死亡2例(6.3％,2/32),顽固右心衰3例(9.4％,3/32),其余24例(75％,24/32)恢复良好。结论:先心病伴重度肺动脉高压部分双向分流的病例,采用浅低温心跳不停心内直视手术有利于心肺功能保护,术中作房间隔单向活瓣有利于其早期恢复。     

婴幼儿先天性心脏病术后急性肾功能衰竭的腹膜透析治疗

目的探讨腹膜透析（PD）对小儿先天性心脏病（先心病）术后急性肾功能衰竭（ARF）的治疗效果。方法对2例2008年于我院在体外循环下行先心术术后出现急性肾功能衰竭行腹膜透析的临床数据进行分析。结果2例病儿均在低体温体外循环下行先心病根治术,术后均出现肾功能不全并行腹膜透析治疗,分别在3-5天内肾功能恢复。结论对于婴幼儿先天性心脏病术后并发急性肾功能不全,尽早应用腹膜透析是一种较为安全、有效的治疗方法,可以有效改善患者预后。     

Echocardiographic and anatomical correlations in fetal congenital heart disease.

In a series of 1600 pregnancies 34 cases of congenital heart disease were correctly identified by fetal echocardiography. In each case echocardiographic diagnosis was confirmed by anatomical study. Termination of pregnancy was done electively in 14 cases: in six because of the identification of a cardiac anomaly and in the remaining eight because of multiple congenital anomalies. The remaining 20 fetuses died subsequently owing either to the complexity of congenital heart disease or to associated extracardiac abnormalities, which were present in more than half the fetuses with congenital heart disease. There were eight errors in interpretation of the fetal echocardiogram. The outcome of the pregnancy was not influenced by the error in any case. Fetal echocardiography can predict correctly structural malformations of the heart. The technique is sufficiently reliable to give an accurate prognosis in early pregnancy and provide the basis for alterations in obstetric management.     

Echocardiographic and anatomical correlations in fetal congenital heart disease

In a series of 1600 pregnancies 34 cases of congenital heart disease were correctly identified by fetal echocardiography. In each case echocardiographic diagnosis was confirmed by anatomical study. Termination of pregnancy was done electively in 14 cases: in six because of the identification of a cardiac anomaly and in the remaining eight because of multiple congenital anomalies. The remaining 20 fetuses died subsequently owing either to the complexity of congenital heart disease or to associated extracardiac abnormalities, which were present in more than half the fetuses with congenital heart disease. There were eight errors in interpretation of the fetal echocardiogram. The outcome of the pregnancy was not influenced by the error in any case. Fetal echocardiography can predict correctly structural malformations of the heart. The technique is sufficiently reliable to give an accurate prognosis in early pregnancy and provide the basis for alterations in obstetric management.     

Involvement of plasma fibrinogen in coronary artery disease.

Over a period of 12 years, two cases of pulmonary arterial aneurysms were encountered in our autopsy data of 13 cases of congenital heart defects with right-sided infective endocarditis. Pulmonary arterial aneurysms are rare lesions and may be categorized as central or peripheral. Although early reports implicated tuberculosis as a major aetiologic factor, pulmonary arterial aneurysms are generally associated with congenital heart disease.     

Initial experience with cardiac resynchronization therapy for ventricular dysfunction in young patients with surgically operated congenital heart disease

Data regarding cardiac resynchronization therapy (CRT) in pediatric patients are limited. The first reported use of CRT in a young patient with congenital heart disease showed promising early results with improvement in New York Heart Association classification, aerobic capacity, and ventricular contractility 1 month after implant. Other reports have shown acute benefits of CRT in young patients with postoperative right bundle branch block after surgery for congenital heart defects. To date, however, there are no published data regarding CRT for the long-term management of systemic ventricular dysfunction in the young with associated congenital heart disease. This report describes our initial experience with CRT in these patients.     

新生儿心脏手术132例麻醉处理

目的 探讨新生儿心脏手术的麻醉处理。方法 行心脏手术患儿132例，年龄9h～31d，体重1.12～4.15kg，经气管插管行静脉复合全身麻醉。结果 主动脉阻断时间84～200min，体外循环时间135～600min，术中死亡8例，其余124例心脏自动复搏;术后渗血16例;肺部感染8例;无麻醉并发症。结论 平稳的复合麻醉，术中早期纠正凝血功能，早期使用血管活性药物，加强肺保护，有利于新生儿心脏手术的成功。     

Secundum atrial septal defect in two families

Two families having secundum atrial septal defect (ASD) were reported. In one family, a 31-year-old male and his 60-year-old mother had secundum ASD without PR prolongation. His 38-year-old brother was diagnosed as having ASD. His grandmother, who had died at the age of 51, was suspected of having congenital heart disease. From early childhood she was noticed to have heart murmur. It was suspected that this was a case of familial ASD without PR prolongation, because it was consistent with the dominant trait of the defect. In the other family, a 16-year-old female had secundum ASD and her 18-year-old brother was also suspected of having ASD. Her 25-year-old brother had been operated on for tetralogy of Fallot, and her sister had died of an unknown congenital heart disease. All of these family members had mental retardation. Her 22-year-old brother was suspected of having a congenital heart disease, because of heart murmur from his early childhood. The parents, who were blood relations (cousins), had neither heart disease nor mental retardation. The children of this family were considered to be cases of congenital heart disease with ASD, associated with mental retardation. It was also suspected that the cause of the defect was a deleterious autosomal recessive gene.