舒适护理在小儿先天性心脏病手术中的应用

目的：探讨先天性心脏病患儿进行舒适护理的价值。方法将48例先天性心脏病封堵手术的患儿随机分为观察组和对照组各24例。对照组只进行普通常规护理,观察组在常规护理的基础上进行舒适护理,比较两组患儿术后并发症和平均住院时间。结果经过舒适护理干预后,观察组发生术后并发症人数比对照组少,差异有统计学意义（P＜0．05）。观察组住院时间为（5．38±1．77）d,低于对照组（6．94±2．04）d,差异有统计学意义（P＜0．05）。结论对小儿先天性心脏病手术患者采取舒适护理,患儿能实现舒适治疗的效果,降低并发症,缩短住院时间。     

伢典微创凝胶治疗小儿龋齿的临床疗效观察

目的探究伢典微创凝胶治疗小儿龋齿的临床效果、并发症及对咀嚼功能评价影响。方法选取2017年1月至12月湖南省儿童医院口腔科收治的龋齿患儿128例为研究对象,随机分为观察组和对照组各64例。对照组应用常规的牙钻磨牙法予以治疗,观察组采取伢碘微创凝胶法予以治疗,对比两组患儿的疼痛程度、临床治疗效果、生活质量、并发症及咀嚼功能。结果观察组疼痛度低于对照组,差异有统计学意义(P0.05)。经过治疗观察组患儿总有效率为95.31%(61/64),显著高于对照组67.19%(43/64),差异有统计学意义(P0.05)。治疗护理后,观察组生活质量(社会、认知、角色、躯体4项)功能评分显著优于对照组,差异有统计学意义(P0.05)。通过治疗后6个月的随访和复查结果表明,观察组并发症发生率为4.69%(3/64),显著低于对照组18.75%(12/64),差异有统计学意义(P0.05)。经过治疗,两组患儿咀嚼功能均有所改善,观察组患儿的改善状况显著优于对照组,差异有统计学意义(P0.05)。结论伢碘微创凝胶治疗小儿龋齿的疗效显著,其创伤小、疼痛度低,并发症发生率低,提高患儿的生活质量,咀嚼功能有所改善。     

推拿联合穴位热敷治疗小儿先天性肌性斜颈临床观察

目的观察推拿联合穴位热敷治疗小儿先天性肌性斜颈临床效果。方法 2016年9月至2017年9月河南推拿职业学院附属医院儿科收治小儿先天性肌性斜颈患儿83例,随机分为观察组42例和对照组41例。对照组给予推拿手法治疗,观察组加用穴位热敷治疗,对比两组临床疗效及颈部肿块直径。结果观察组总有效率为95.2%(40/42),显著高于对照组63.4%(26/41),差异有统计学意义(P0.05)。治疗后观察组患儿肿块直径显著小于对照组,差异有统计学意义(P0.05)。结论推拿手法配合穴位热敷能够缩小肿块、改善局部肌肉挛缩状态,恢复颈部活动功能,利于患儿预后,值得临床推广。     

阅读疗法在先天性心脏病患儿中的应用效果

目的探讨阅读疗法在先天性心脏病患儿中的应用效果。方法选取2017年11月至2018年12月本院收治的先天性心脏病患儿90例,随机分为观察组与对照组各45例。对照组给予常规口头宣教与疾病护理干预,观察组在对照组的基础上应用"住院患儿阅读疗法读本"进行阅读疗法干预,比较两组患儿围术期的心率水平、手术配合情况、术后焦虑状态、术后疼痛状态。结果两组患儿夜间睡眠时与麻醉后心率水平比较差异无统计学意义(P0.05);观察组患儿离开病房时、麻醉诱导时心率水平低于对照组,差异有统计学意义(P0.05)。观察组患儿麻醉诱导抗拒评分、苏醒期躁动评分均低于对照组,差异有统计学意义(P0.05)。观察组术后1～8 d焦虑状态评分低于对照组,差异有统计学意义(P0.05)。两组患儿术后1、7、8 d疼痛行为评分比较,差异无统计学意义(P0.05);观察组术后2～6 d疼痛行为评分低于对照组,差异有统计学意义(P0.05)。结论阅读疗法可有效降低先天性心脏病患儿围术期的焦虑状态,加强患儿围术期的配合程度,减轻患儿术后疼痛程度。     

不同药物雾化吸入治疗小儿支气管哮喘92例临床疗效分析

目的:探讨不同药物雾化吸入治疗小儿支气管哮喘的临床疗效。方法:将92例支气管哮喘患儿随机分为布地奈德联合沙丁胺醇雾化吸入治疗组(观察组)和单纯布地奈德雾化吸入治疗组(对照组),每组各46例,比较两组临床疗效。结果:观察组临床治疗总有效率为93.5%,显著高于对照组的73.9%,且两组间总有效率之间的差异有统计学意义(P<0.05)。观察组2例患儿治疗后出现口干,不良反应发生率为4.3%,对照组3例患儿出现口干,2例患儿声音嘶哑,2例患儿出现心悸,不良反应发生率为15.2%,两组不良反应发生率之间的差异未见统计学意义(P>0.05)。结论:布地奈德联合沙丁胺醇雾化吸入治疗小儿支气管哮喘临床疗效好,不良反应发生率低,值得临床进一步推广使用。     

干预性呼吸治疗在婴幼儿先天性心脏病围手术期的应用

目的探讨干预性呼吸治疗改善先天性心脏病患儿术后呼吸功能的效果。方法选择2017年11月至2018年4月湖南省儿童医院收治的先心病患儿40例为研究对象,随机分为观察组与对照组各20例。分别给予常规呼吸治疗方法和干预性呼吸治疗方法,分别检测和比较两组患儿呼吸机辅助时间和心脏重症监护室停留时间、二次气管插管率、动脉血气分析指标,通气/血流比以及胸片结果。结果观察组患儿呼吸机辅助时间和心脏重症监护室滞留时间均显著短于对照组,差异有统计学意义(P0.05)。观察组二次气管插管率为10.0%(2/20),显著低于对照组65.0%(13/20),差异有统计学意义(P0.05)。观察组治疗后血PCO_2和PO_2均显著优于对照组,差异有统计学意义(P0.05);两组血氧饱和度比较差异无统计学意义(P0.05)。两组患儿治疗后通气/血流比值由治疗前的失调均得到明显平衡和改善。观察组并发症发生率为5.0%(1/20),显著低于对照组55.0%(11/20),差异有统计学意义(P0.05)。结论干预性呼吸治疗能改善先天性心脏病患儿术后呼吸功能和肺通气,提高手术成功率。     

TBX1基因多态性与先天性心脏病的相关性

目的探讨TBX1基因多态性与先天性心脏病(先心病)的相关关系。 方法选择2004-10—2005-03在哈尔滨医科大学附属第二医院住院的先心病患儿99例，对照组96名(与先心病患儿年龄相近的健康儿童)。应用小剂量DNA提取技术及采用ABI Prism SNaPshot方法,检测了先心病患儿和对照组儿童的TBX1基因多态性。 结果经χ2检验，TBX1基因各基因型频率在对照组、先心病组之间均无显著性差异(P>005)；各等位基因频率在两组人群中差异均无显著性意义(P>005)。 结论未发现TBX1基因多态性与先天性心脏病之间存在相关关系。     

介入治疗与开胸手术治疗小儿室间隔缺损的临床疗效对比

目的对比介入治疗与开胸手术治疗小儿室间隔缺损临床疗效。方法 2014年3月至2016年4月湖南省儿童医院心胸外科收治住院的小儿室间隔缺损患儿150例,依据治疗方案将接受介入治疗的50例患儿为观察组,接受开胸手术治疗的100例患儿为对照组。两组手术成功率、手术时间、术后住院时间、并发症发生率。结果两组手术成功率比较差异无统计学意义(P0.05);观察组手术时间与术后住院时间均显著小于对照组,差异有统计学意义(P0.05)。对照组术后并发症发生率为14%(14/100),显著高于观察组2%(1/50),差异有统计学意义(P0.05)。结论相对于开胸手术,介入治疗小儿室间隔缺损疗效理想且安全性高,可作为优选治疗方案推广使用。     

玉屏风口服液联合转移因子口服液治疗小儿反复呼吸道感染疗效观察

目的观察玉屏风口服液联合转移因子口服液治疗小儿反复呼吸道感染疗效。方法将76例反复呼吸道感染患儿随机分为观察组和对照组各38例,观察组采用常规和转移因子口服液治疗,观察组在此基础上加玉屏风口服液治疗,对比两组患儿临床疗效和血清免疫球蛋白变化。结果观察组总有效率86.84%(33/38),对照组73.68%(28/38),两组比较差异有统计学意义(P0.05);观察组患儿血清免疫球蛋白高于对照组,差异有统计学意义(P0.05)。结论玉屏风口服液联合转移因子口服液治疗小儿反复呼吸道感染效果显著,值得推广。     

喜炎平注射液治疗小儿急性细菌性肠炎30例疗效观察

目的 观察喜炎平注射液对小儿急性细菌性肠炎的治疗效果.方法 将60例小儿急性细菌性肠炎患儿随机分为对照组和观察组各30例.对照组给予注射用头孢呋辛钠治疗;观察组给予喜炎平注射液治疗,两组均连用3～5 d.比较两组临床疗效、便常规及不良反应.结果 两组总有效率相当,差异无统计学意义（P〉0.05）.两组便常规转阴率比较差异无统计学意义（P〉0.05）,不良反应情况对比差异无统计学意义（P〉0.05）.结论 喜炎平注射液对小儿急性细菌性肠炎有一定疗效,无明显副反应.     

心脏矫正术对先天性心脏病妇女妊娠结局影响的Meta分析

目的：探讨孕前行心脏矫正术对先天性心脏病（先心病）孕产妇妊娠结局的影响。方法：检索2018年9月以前在中国知网（CNKI）、万方数据库（WangFang data）、维普数据库（VIP）、PubMed、Cochrane Library等数据库关于孕前心脏矫正术对先心病孕产妇妊娠结局影响的文献。对纳入文献进行质量评价及数据提取,使用RevMan 5.3软件对数据进行Meta分析。结果：共纳入17个队列研究共1 181例患者,其中手术组457例,未手术组724例。对于先心病妇女,孕前的心脏矫正术可以改善孕妇的心功能情况,心力衰竭发生率、剖宫产率、早产率、胎儿生长受限发生率、小于胎龄儿发生率、新生儿窒息发生率及围生儿死亡率与未手术组比较差异均有统计学意义（均P＜0.05）。然而,关于孕妇的死亡率及新生儿心脏病发生率,2组间比较差异无统计学意义（均P＞0.05）。结论：相比于孕前未行心脏矫正术的先心病患者,手术患者能取得较为理想的妊娠结局。     

心血管整体评分评估胎儿心功能不全的价值

目的：探讨心血管整体评分（CVPS）对胎儿心功能不全评估的价值。方法：对2013年1月—2016年1月来天津市中心妇产科医院超声中心就诊的孕妇行常规超声检查,检出其中有心功能异常表现（心脏增大、心肌收缩乏力）的胎儿,记录CVPS评分结果,同时行胎儿超声心动图检查,确定有无心内结构异常。依据追访结果,将病例分为2组：活产组和不良妊娠结局组。结果：共检出心功能不全胎儿38例,其中单胎35例,双胎3例。活产组12例,均为单胎,出生后体健10例,2例合并先心病：1例肺动脉瓣轻度狭窄,1例法乐四联症。不良妊娠结局组21例。单胎不良妊娠结局共18例,其中宫内死胎9例,死产2例,引产7例：CVPS持续降低心功能逐渐恶化直至心力衰竭5例,合并难治型先心病2例。双胎中2例为双胎输血综合征（TTTS）宫内死胎,1例为胎儿脑积水、颅内出血引产。失访5例。活产组胎儿CVPS的中位数（四分位数间距）[M（Q）]为7.62（7.00）,不良妊娠结局组胎儿CVPS的M（Q）为5.67（3.50）。受试者工作特征（ROC）曲线分析,曲线下面积（AUC）0.823,Cut-off值为6.5,P=0.002,有统计学意义。活产组胎儿脐动脉频谱评分、静脉频谱评分和心脏瓣膜功能评分均高于不良妊娠结局组,差异有统计学意义（均P＜0.05）。结论：随着胎儿心功能不全加重直至心力衰竭,CVPS逐渐降低,CVPS危险临界值为6.5,CVPS是连续动态评估胎儿心功能不全的有效指标。胎儿脐动脉频谱、静脉频谱及心脏瓣膜功能评分对预测不良妊娠结局具有一定价值。     

儿童非紫绀型先天性心脏病体外循环术后急性肾损伤相关危险因素分析

目的探究儿童非紫绀型先天性心脏病体外循环术后急性肾损伤(AKI)相关危险因素。方法选取2013年8月至2016年8月在湖南省儿童医院心胸外科行体外循环手术治疗的非紫绀型先天性心脏病患儿450例作为研究对象,将患儿按术后是否出现AKI进行分组,AKI组80例,非AKI组370例。收集患儿的一般资料及临床资料,通过单因素分析以及Logistic回归分析探究其相关危险因素。结果两组患儿在性别、体质量、尿素氮、左室射血分数、血红蛋白方面比较差异无统计学意义(P0.05)。两组在年龄、血肌酐、肺炎或心力衰竭史、体外循环时间及主动脉阻断时间、术后低血压方面比较差异有统计学意义(P0.05)。通过Logistic对因素回归分析发现,年龄≤1岁、肺炎或心力衰竭史、体外循环时间以及主动脉阻断时间是危险因素。结论在非紫绀型先天性心脏病患儿行体外循环手术治疗中,选择手术年龄、缩短体外循环时间、缩短主动脉阻断时间以及预防并发症是有效的控制手段,可以降低患儿AKI的发病率。     

Pregnancy in patients with heart disease

PURPOSE: The study was carried out to ascertain the experience of pregnant women with cardiac disease in one referral center. METHODS: From 1986 to 2004, 242 pregnant women with heart disease were followed by the same obstetrical and cardiology center. The cardiac diagnosis was additionally confirmed with echocardiography and heart catheterization during cardiosurgery. The subjects were classified into groups with respect to the congenital heart abnormality type, and cardiovascular insufficiency according to the NYHA classification. The results from the evaluated groups were compared to a control group. RESULTS: A significant increase in percentage of congenital heart disease was found, however acquired cardiac defects prevailed. A significant increase in rate of congenital heart disease was found. A higher incidence of cesarean sections in women with underlying heart disease with respect to the control group was also found. CONCLUSIONS: In pregnant women with underlying heart disease, congenital heart disease is presently more frequent than acquired heart disease compared to the situation in the beginning of the analysis. Pregnancy duration time depends on cardiac sufficiency and it is statistically shorter in NYHA class III and IV patients.     

Contribution of 3D-ultrasound in the heterotaxy syndromes: about four cases and review of the literature

The position or location of the organs and vessels is usually classified into three types: situs solitus, situs inversus, and situs ambigus. Situs solitus is the usual arrangement of organs and vessels within the body. Only 0.6 to 0.8% of patients with situs solitus and levocardia have associated congenital heart diseases. Situs inversus refers to an anatomic arrangement that is the mirror image of situs solitus. The incidence of congenital heart disease is increased to 3 to 5% in the patients with situs inversus. The patients with heterotaxy have congenital heart disease in high incidence, ranging from 50 to nearly 100%. We present four cases diagnosed in our department in a period of 18 months. With these four cases and a review in the literature, we explore the definitions and characteristics of heterotaxy syndromes and we study the role of 3D ultrasound.     

Mitral valve surgery and maternal and fetal outcome in valvular heart disease.

OBJECTIVES: To compare maternal and fetal outcomes in patients with non-operated valvular heart disease and patients who had surgery before or during pregnancy. METHODS: The 308 women with valvular heart disease who delivered in this hospital in the last 8 years were divided into three groups. The 218 (70.7%) women in group 1 had no surgical intervention; the 42 (13.6%) women in group 2 underwent balloon mitral valvotomy during pregnancy; and the 48 (15.5%) women in group 3 had surgical intervention before pregnancy (35 had balloon mitral valvotomy, eight had mitral valve replacement, and five had mitral valve repair). Maternal and fetal outcomes were compared for these three groups. RESULTS: The antenatal events differed significantly: 175 (80.3%), 40 (94.2%), and 46 (95.8%) patients in groups 1, 2 and 3, respectively, had uneventful pregnancies. In group 1, 14 (6.4%) patients had congestive heart failure (P>0.05) and 24 (11%) patients had cardiac arrhythmias, which was statistically significant. The rate of preterm deliveries did not differ significantly among the three groups. The groups did not differ in mean birth weight, mode of delivery, low birth weight, Apgar scores less than 8, stillbirths, neonatal death, or congenital anomalies. CONCLUSIONS: Mitral valve surgery before or during pregnancy did not significantly improve maternal and fetal outcomes but decreased adverse events such as congestive heart failure and cardiac arrhythmias. It should be therefore performed only in selected cases.     

妊娠合并先天性心脏病伴肺动脉高压79例妊娠结局分析

目的分析妊娠合并先天性心脏病伴肺动脉高乐患者的妊娠结局。方法回顾性分析2009年1月至2013年6月北京安贞医院妇产科收治的79例妊娠合并先天性心脏病伴肺动脉高压患者的临床资料,根据肺动脉压力将其分为轻度组、中度组、重度组。分析各组先天性心脏病种类、心功能级别、终止妊娠的方式以及母婴结局。结果先心病类型以房间隔缺损（房缺）和室间隔缺损（室缺）为主,肺动脉高压轻度组心功能以Ⅰ～Ⅱ级为主,重度组心功能以Ⅲ～Ⅳ级为主。79例患者中,行医源性流产者16例（20．8％）,经阴道分娩5例（6．5％）,剖宫产56例（72．7％）。重度组医源性流产率高于其他组,足月分娩率低于其他组,差异有统计学意义（P〈0．05）。新生儿早产20例（32．8％）,足月产41例（67．2％）,死产1例,随着肺动脉压力的增加,早产的发生率增加,三组之间相互比较差异有统计学意义（P〈0．05）。结论肺动脉高压患者应在妇产科及心脏科医师指导下妊娠,不宜妊娠者应及早终止妊娠。孕产妇终止妊娠方式以剖宫产为主,麻醉方式以硬膜外麻醉为宜。     

455例妊娠合并心脏病患者不同心功能状况对妊娠结局的影响

目的探讨妊娠合并心脏病不同心脏功能对妊娠结局的影响。方法对北京大学第三医院1994年1月至2008年12月间妊娠合并心脏病455例患者的临床资料进行回顾性分析。结果妊娠合并心脏病以心律失常（223例,49.01%）和先天性心脏病（140例,30.77%）最为常见,风湿性心脏病居第三位（33例,7.25%）。妊娠合并心律失常患者心功能均为Ⅰ～Ⅱ级,妊娠合并先天性心脏病患者心功能为Ⅰ～Ⅱ级者为135例,Ⅲ～Ⅳ级为5例,其中1例为为妊娠合并艾森曼格综合征,产后7 d猝死;妊娠期高血压性心脏病17例心功能Ⅲ～Ⅳ级,其中1例孕妇死亡;围生期心肌病5例,其心功能均为Ⅳ级。心脏功能Ⅲ～Ⅳ级患者的妊娠孕周明显小于心功能Ⅰ～Ⅱ级（P〈0.05）,医源性早产和围产儿死亡率显著增加（P〈0.01）。结论心脏功能Ⅲ～Ⅳ级患者以妊娠期高血压性心脏病、先天性心脏病和围生期心肌病多见,其医源性早产、孕产妇及围产儿死亡的发生增加。妊娠合并心脏病患者的心脏功能状态与其孕产妇及围产儿结局密切相关。     

HLHS--congenital heart defect in High Risk Pregnancy Unit in 2001-2007

BACKGROUND: HLHS (hypoplastic left heart syndrome) is a serious congenital heart defect. In neonates with congenital heart disease HLHS accounts for nearly 25% of neonatal deaths. The etiology of HLHS is unknown. At present we expect to have those cases diagnosed in the second trimester of pregnancy. AIM: The main aim was to find the rate and outcome of the congenital heart defect--left heart hypoplasia (HLHS). MATERIAL AND METHODS: All cases of this heart defect found in the High Risk Pregnancy Clinic in 2001-2007 were presented. Twice the congenital malformation was diagnosed after delivery and once during pregnancy--in the second trimester. All babies were delivered between 38 and 39 weeks of pregnancy, one by the spontaneous normal delivery, one by elective caesarean section and one by emergency caesarean section because of fetal distress during the delivery. All of the newborns were transported to the Pediatric Cardio surgery Unit of M.U. and operated in first weeks after delivery. RESULTS: In two cases the operation was complicated and children died due to the cardiac arrest. One of the babies died before surgical correction. Two of the women, whose babies died after the operation gave birth to healthy newborns with no cardiac abnormalities. CONCLUSION: The HLHS is the most serious heart congenital malformation diagnosed often after the delivery because of lack of sufficient diagnostic system in healthy women. The prognosis for the children is bad, but the chance of giving birth to healthy children in the future is good.