危重肺动脉瓣狭窄及闭锁新生儿经导管介入治疗的护理

总结17例新生儿期患儿采用经导管介入方法治疗危重肺动脉瓣狭窄及室间隔完整型肺动脉瓣闭锁的护理。患儿入室前完善各监护仪、抢救物品及药品的准备,认真核对患儿术前各项检查结果,控制室温27-29℃,并对手术床进行加温;患儿入室后用小枕协助置合适体位,并根据季节需要选用加温的布类包裹四肢固定后,设置射频打孔发生器于备用状态,严密监测患儿生命体征变化,及时清理呼吸道分泌物。本组术中4例出现并发症,其中2例心包积血,1例低氧血症,1例室上性心动过速,由于发现及时,积极干预后均预后良好。17例患儿介入治疗均获成功,存活16例,1例术后1d突发病情变化猝死。     

危重肺动脉瓣狭窄及闭锁新生儿经导管介入治疗的护理

总结17例新生儿期患儿采用经导管介入方法治疗危重肺动脉瓣狭窄及室间隔完整型肺动脉瓣闭锁的护理。患儿入室前完善各监护仪、抢救物品及药品的准备,认真核对患儿术前各项检查结果,控制室温27～29℃,并对手术床进行加温;患儿入室后用小枕协助置合适体位,并根据季节需要选用加温的布类包裹四肢固定后,设置射频打孔发生器于备用状态,严密监测患儿生命体征变化,及时清理呼吸道分泌物。本组术中4例出现并发症,其中2例心包积血,1例低氧血症,1例室上性心动过速,由于发现及时,积极干预后均预后良好。17例患儿介入治疗均获成功,存活16例,1例术后1 d突发病情变化猝死。     

7例动脉导管内支架治疗新生儿室间隔完整型肺动脉闭锁的围手术期护理

探讨7例动脉导管内支架治疗新生儿室间隔完整型肺动脉闭锁(PA-IVS)的圈手术期护理.术前做好用药护理、合理用氧、完善术前准备;术后及时发现并处理股动脉和股静脉穿刺点渗血、下肢肿胀和血栓形成等并发症.本组均介入治疗成功,安全出院.     

24例Ⅲ型食管闭锁新生儿围手术期护理

对24例接受手术治疗的Ⅲ型食管闭锁新生儿进行手术前后监护,总结围术期的护理措施:术前加强临床护士在早期诊断中的重要作用,确诊后加强呼吸道护理,改善机体内环境,提高手术后存活率及减少并发症;术后监护重点是强化气道和支撑胃管的管理,保证热量供给和营养支持;后期护理重点是正确的喂养。20例治愈,治愈率为83%,家长放弃治疗4例,其中死亡2例。     

新生儿重症肺动脉瓣狭窄经皮球囊肺动脉瓣成形术的护理配合

总结了19例新生儿行危重症肺动脉瓣狭窄经皮球囊肺动脉瓣成形术的护理配合.术中重点观察患儿呼吸、经皮脉搏血氧饱和度、血压、心律、心率等的变化,加强全身麻醉的配合和药物的安全使用,防止并发症的发生.本组6例术中出现一过性室性期前收缩,1例心动过缓,5例血压和血氧饱和度下降,1例术中急性心包填塞,外科紧急手术修补.经针对性的治疗及处理,18例新生儿各项生命体征监测指标均稳定,顺利完成手术.     

新生儿先天性肠闭锁36例围手术期的护理

新生儿先天性肠闭锁是一种临床上较多见的一种疾病,它属于一种先天肠道畸形,该病由于胎儿期胎肠发育过程中局部血液循环障碍而导致缺血坏死,断裂或缺失,是新生儿期需要立即手术治疗的疾病。我科自2006-2011年共收治36例,经过手术治疗及精心的护理,患儿预后良好,现报道如下。1临床资料1.1一般资料本组患儿共36例。其中男16例,女20例,年龄2～3d,其中早产儿3例。出生体重2.2～3.6kg,其中1例并发多指畸形。患儿出生后出现吃奶呕吐,腹胀明显,24h     

新生儿先天性肠闭锁31例围手术期的护理

目的探讨新生儿先天性肠闭锁手术前后的护理。方法对31例先天性肠闭锁的新生儿术前静脉营养,纠正水电解质紊乱,注意保暖,术后要严密监测患儿生命体征,密切观察病情变化,预防感染等并发症发生。结果 31例先天性肠闭锁及肠狭窄痊愈出院28例,多发性畸形家长放弃治疗死亡1例,再次梗阻1例,并发切口症1例。结论精心的护理减少先天性肠闭锁的新生儿手术前后的病死率,提高其生存质量。     

先天性肠闭锁及肠狭窄的新生儿围手术期的护理

目的 探讨广东医学院附属医院儿科ICU对先天性肠闭锁及肠狭窄的新生儿手术前后的护理体会。方法 对13例先天性肠闭锁及肠狭窄的新生儿手术前后的护理体会进行分析。术前要注意静脉营养，纠正电解质紊乱，注意保暖；术后要严密监测患儿生命体征，密切观察病情变化，预防感染等并发症发生。结果 13例先天性肠闭锁及肠狭窄的新生儿手术后在医务人员的精心护理下，痊愈出院8例，转当地医院治疗2例，死亡3例。结论 精心严密、适当有效的护理可有效减少先天性肠闭锁及肠狭窄的新生儿手术前后的死亡率，提高其生存质量。     

20例新生儿鳃裂囊肿的围手术期护理

探讨新生儿鳃裂囊肿的固手术期护理方法.20例患儿均明确诊断鳃裂囊肿,行囊肿摘除术.患儿围术期的呼吸道管理、饮食管理和切口护理对减轻患儿呼吸困难、防止呛咳误吸及切口的早日愈合均有积极作用.20例患儿术后恢复良好,随访1个月至4年无复发.     

新生儿危重症肺动脉瓣狭窄经皮球囊成形术的护理

肺动脉瓣狭窄（pulmonarys tenosis）为右室流出道梗阻的先天性心脏病。临床上肺动脉瓣狭窄患儿约占所有先天性心脏病患儿的25％～30％。先天性心脏病肺动脉瓣狭窄的传统治疗方法为深低温、停循环下开胸手术。     

Surgical management of pulmonary atresia, and critical pulmonary stenosis with intact ventricular septum

Our experience with the surgical management of hypoplastic right ventricle with intact ventricular septum has included 20 patients with pulmonary atresia and 3 patients with critical pulmonary stenosis. Group 1 consisted of 7 infants who were treated by transarterial pulmonary valvotomy. Four of them were lost shortly after surgery. Group 2 included 11 neonates and one infant who were treated by systemic-pulmonary shunt with 2 operative death. Group 3 included 4 infants who underwent primary prosthetic enlargement of the right ventricular outflow tract. Two of the 4 were lost in the early postoperative period. Eight of 13 patients in groups 1 and 2 who survived the initial palliative procedures underwent additional operations to enlarge the right ventricular outflow tract, and 5 patients survived. However, adequate right ventricular and tricuspid valve growth was obtained in only patients in whom the prosthetic enlargement of the right ventricle was performed in early infancy. These findings strongly suggest the necessity to decompress the right ventricle completely, as early as possible. In conclusion, 1) transarterial pulmonary valvotomy seldom provided satisfactory decompression of the right ventricle, and operative risk was high. 2) systemic-pulmonary shunt to re-establish pulmonary blood flow improved neonatal survival, although this procedure may not provide a satisfactory long term palliation. 3) primary or secondary operative enlargement of the right ventricle in early infancy provided decompression of the right ventricle and accelerated substantial right ventricular growth. For patients without an infundibulum or for those in whom attempts to induce tricuspid valve growth had failed, a Fontan type procedure seemed to be the procedure of choice.     

室间隔完整的肺动脉闭锁的心血管造影诊断

目的研究室间隔完整的肺动脉闭锁(PA/IVS)心血管造影的诊断价值.方法回顾分析16例PA/IVS的心血管造影表现,结合X线平片、超声心动图、电子束CT结果进行分析比较.结果 16例行心血管造影均明确诊断;行X线胸片16例初步定性诊断;超声心动图检查16例,明确诊断15例,误诊1例;电子束CT检查2例,清楚显示肺动脉发育.结论 PA/IVS诊断主要依靠心血管造影.造影中应重点注意右室、肺动脉发育情况,体肺侧支及是否伴有房间隔缺损、动脉导管未闭等,为临床治疗提供重要信息.     

胎儿室间隔完整的肺动脉闭锁1例

孕妇21岁,孕1产0,孕21周,身体健康,无遗传病史,孕期无感染及服药史,于我院接受产前超声检查.胎儿超声心动图:腹主动脉与下腔静脉的位置关系正常,四腔心切面清晰显示,左心室明显扩大,右心室缩小,右心房比左心房大,二尖瓣及三尖瓣清楚,启闭运动均见,室间隔未探及明确回声失落,左心房侧探及活瓣甩动,长约5.4 mm,房间隔中部可见卵圆孔无回声区,宽约3.5 mm;长轴切面见主动脉起自左心室,右心室流出道切面探及肺动脉起自右心室,探及肺动脉瓣回声,未探及明确开闭运动.     

肺动脉瓣切开术在室间隔完整肺动脉闭锁的中期疗效

目的分析肺动脉瓣直视切开术治疗右心室轻、中度发育不良室间隔完整肺动脉闭锁(PA/IVS)的中期疗效。方法回顾性分析我院自1995年1月至2013年10月收治的15例肺动脉瓣直视切开术治疗PA/IVS患儿临床资料。手术时中位年龄4个月(7 d至32个月),其中女8例,男7例;术前根据超声检测三尖瓣Z值以判断右心室发育程度,患儿三尖瓣Z值皆>-4,即右心室轻、中度发育不良。其中12例施行肺动脉瓣切开,3例肺动脉瓣切开和体-肺动脉分流术。结果手术后死亡1例(死亡率为6.7%),患儿血氧饱和度明显改善(0.82±0.04 vs.0.91±0.05,P<0.01),右心室压力与体循环压力比值明显下降(1.85±0.14 vs.0.78±0.15,P<0.01)。平均随访5.2年(1~8年),死亡1例。其中9例患儿施行二期手术(7例两心室修复,2例双向腔肺动脉分流术),无手术死亡,近期随访满意。术后6个月、1年、2年和3年的二次手术免除率分别为92.9%、85.7%、62.9%和39.3%。所有患儿心功能NYHA分级Ⅰ级。结论对于PA/IVS患儿的外科治疗,依据术前三尖瓣Z值,选取右心室轻、中度发育不全患儿,应用肺动脉瓣直视切开术,可获得满意的疗效。     

Pulmonary stenosis and atresia with intact ventricular septum during prenatal life.

AIM: To identify fetal echocardiographic characteristics predictive of perinatal outcome in cases with a prenatal diagnosis of pulmonary stenosis or pulmonary atresia. PATIENTS AND METHODS: We retrospectively reviewed the records and the videotapes of all the cases of pulmonary stenosis and pulmonary atresia diagnosed at our institutions between 1990 and 1999. The following measurements were obtained: diameters of right and left atria and ventricles and ventricular wall thickness; main pulmonary artery and aortic root diameter; direction of flow through the atrioventricular, aortic and pulmonary valves and through the ductus arteriosus. Perinatal outcome and follow-up of the survivors were available in each case. RESULTS: There were 21 cases of pulmonary atresia. Eleven were diagnosed before 24 weeks and nine of them (82%) underwent termination of pregnancy. The survival rate was 50% among the 12 fetuses born at term. None of the fetuses that survived had a large right ventricle, while this was a finding in 50% of those that died. Among the fetuses that died, 83% had a hypertrophic right ventricular wall compared to 33% of the survivors. There were 12 cases of pulmonary stenosis. Three cases were diagnosed before 24 weeks but none underwent termination of pregnancy. All the fetuses with pulmonary stenosis were born at term and four died in the perinatal period. The survival rate was thus 66.6% (8/12). Three (75%) of the fetuses that died had reversed flow in the ductus arteriosus compared with one of the fetuses that survived. CONCLUSION: Our data suggest that a grossly enlarged right ventricle and/or a hypertrophied right ventricular wall in cases of pulmonary atresia and reversed flow in the arterial duct in cases of pulmonary stenosis are likely indicators of a poor prognosis.     

10例室间隔完整型肺动脉闭锁患儿的术后护理

回顾性分析10例室间隔完整型肺动脉闭锁患儿的术后护理,术后关键在于维护患儿循环功能稳定,做好呼吸管理及针对家长的出院宣教和随访.术后早期死亡1例,死因为右心衰竭;9例随访6个月至3年,一般情况良好.     

超声心动图诊断室间隔完整的肺动脉瓣闭锁1例

患儿女,73天,以"生后口唇、四肢末端青紫"就诊.体格检查:一般情况差,心率178次/分,胸骨左缘第2肋间闻及2～3/6级收缩期杂音.心血管造影提示:肺动脉瓣闭锁合并动脉导管未闭;房间隔缺损.     

儿童肺动脉闭锁伴室间隔完整的多排螺旋CT诊断及分型复习

目的：分析总结肺动脉闭锁伴室间隔完整（PA/IVS）的CT影像表现及分型,讨论与PA/VSD的不同。方法：分析PA/IVS的右心房、右心室、肺动脉、主动脉、三尖瓣及合并畸形的CT影像表现并分型。结果：5例右心室发育不良,1例右心室大小正常,1例右心室增大。5例肺动脉瓣闭锁,肺动脉正常;2例主肺动脉闭锁,1例伴双肺动脉近端狭窄,1例伴双肺动脉发育不良。6例合并PDA,4例合并ASD,1例双侧冠状动脉共干起源,1例右冠状动脉-右心室瘘,1例伴降主动脉侧支。依据Greenwold分型,Ⅰ型5例,Ⅱ型2例。结论：PA/IVS的CT影像特点是室间隔完整,肺动脉瓣闭锁多见,主肺动脉和双侧肺动脉的形态多正常,多数没有降主动脉重要侧支,与PA/VSD的CT表现明显不同。