先天性心脏病合并肺动脉高压患儿的围手术期护理

目的 :探讨先天性心脏病合并肺动脉高压患儿的围术期护理。方法 :对5 6例先天性心脏病合并肺动脉高压患儿加强围手术期护理 ,给予有效的镇静、止痛、肌松药、高浓度氧气吸入、适宜的过度通气等护理措施。结果 :本组除 2例术后早期死于呼吸衰竭和低心排外 ,其余 5 4例均痊愈出院 ,无护理并发症发生。结论 :先天性心脏病合并肺动脉高压患儿术后护理难度大、危险高 ,细致、规范的护理是提高手术成功率、减少并发症的重要保证     

心脏瓣膜病变合并重度肺高压手术后的护理

目的探讨心脏瓣膜病变合并重度肺动脉高压手术后护理方法。方法1994年6月-2006年1月期间我院共收治心脏瓣膜病变合并重度肺高压者(平均肺动脉收缩压≥100mmHg)132例。术后护理主要为:给予充足的氧气及定时翻身、拍背等,保持呼吸道通畅,根据血气分析调节氧的浓度、呼吸比值相应延长机械通气时间;同时使用扩张肺血管,降低肺高压的药物;预防肺高压危象及肺部并发症。结果132例患者中术后出现肺部并发症共5例,其中3例肺不张,2例肺高压危象,死亡2例,死亡率为1.5%。结论精心的护理可减少肺部并发症,降低死亡率,提高手术成功率。     

小儿先心病合并肺动脉高压围术期护理

目的探讨先天性心脏病合并肺动脉高压患儿的围术期护理措施和要点。方法总结29例先天性心脏病合并肺动脉高压患儿加强围手术期护理,给予有效的镇静、肌松药、加强呼吸道护理及血流动力学观察和护理。结果3例患儿术后出现肺动脉高压危象,29例患儿均顺利撤离呼吸机,痊愈出院,无护理并发症发生。结论先天性心脏病合并肺动脉高压患者围术期护理,特别是呼吸道及循环系统护理对于手术的成败和减少并发症的发生尤其重要。     

诊断性治疗先天性心脏病伴重度肺动脉高压的护理

目的探讨先天性心脏病伴重度肺动脉高压患者诊断性治疗期间的观察与护理。方法对32例先天性心脏病伴重度肺动脉高压患儿应用肺血管扩张药物行诊断性治疗,通过定时观察用药前后患儿四肢末梢血氧饱和度的变化以确定手术时机。结果 32例患儿中有26例经用药后,四肢末梢血氧饱和度由治疗前的86%～92%提高至95%以上,达到手术指征。其中25例围术期恢复顺利,1例因术后出现肺动脉高压危象死亡。结论通过联合应用肺血管扩张药物,可以为先天性心脏病伴重度肺动脉高压患儿的手术治疗带来转机。护理的重点在于观察用药后患儿四肢血氧饱和度的变化和药物不良反应,同时加强治疗期间患儿家属的心理护理。     

心脏瓣膜病变合并重度肺高压手术后的护理

目的 探讨心脏瓣膜病变合并重度肺动脉高压手术后护理方法.方法 1994年6月-2006年1月期间我院共收治心脏瓣膜病变合并重度肺高压者(平均肺动脉收缩压≥100 mm Hg)132例.术后护理主要为:给予充足的氧气及定时翻身、拍背等,保持呼吸道通畅,根据血气分析调节氧的浓度、呼吸比值相应延长机械通气时间;同时使用扩张肺血管,降低肺高压的药物;预防肺高压危象及肺部并发症.结果 132例患者中术后出现肺部并发症共5例,其中3例肺不张,2例肺高压危象,死亡2例,死亡率为1.5%.结论 精心的护理可减少肺部并发症,降低死亡率,提高手术成功率.     

主动脉弓离断伴重度肺动脉高压患儿的术后护理

目的总结主动脉弓离断伴重度肺动脉高压患儿的术后护理经验。方法对2009年10月-2014年10月收治的18例主动脉弓离断伴重度肺动脉高压患儿的术后治疗资料进行回顾性分析。结果术后死亡1例,3例出现肺动脉高压危象,ICU时间3~10 d,机械通气0.8~5 d,出院时上下肢动脉血压相差1.33~2.00 k Pa。结论术后严密观察患者有创动脉血压及血氧饱和度,加强心、肺、肾等脏器功能的监测,注意肺动脉高压的变化指标,及时采取护理措施,预防肺动脉高压危象的发生,对主动脉弓离断伴重度肺高压患儿术后顺利恢复和降低死亡率有重要意义。     

先天性心脏病合并肺动脉高压病人的围术期呼吸道护理

[目的]总结先天性心脏病合并肺动脉高压病人的围术期呼吸道护理措施。[方法]回顾性分析71例先天性心脏病合并肺动脉高压行心脏手术病人的临床资料。[结果]本组病人术后并发肺部感染13例,死亡1例。[结论]加强围术期的护理是先天性心脏病合并肺动脉高压行心脏手术病人术后顺利康复的保证。     

先天性心脏病合并肺动脉高压病人的围术期呼吸道护理

[目的]总结先天性心脏病合并肺动脉高压病人的围术期呼吸道护理措施。[方法]回顾性分析71例先天性心脏病合并肺动脉高压行心脏手术病人的临床资料。[结果]本组病人术后并发肺部感染13例,死亡1例。[结论]加强围术期的护理是先天性心脏病合并肺动脉高压行心脏手术病人术后顺利康复的保证。     

复杂先天性心脏病伴肺动脉高压患儿围手术期的呼吸道护理

目的 总结复杂危重先天性心脏病伴肺动脉高压患儿行体外循环术围手术期呼吸道管理的护理经验.方法 回顾分析2012年7月至2013年2月1 10例复杂危重先天性心脏病伴肺动脉高压行体外循环手术患儿的临床资料,总结围手术期呼吸道管理的护理经验.室间隔缺损、房间隔缺损93例,完全性房室通道6例,主动脉缩窄3例,完全性肺静脉异位引流4例,右室双出口3例,永存左上腔静脉1例,均伴肺动脉高压,肺动脉收缩压≥55 mm Hg;年龄1～12个月,平均(5.6±6.2)个月;体质量3.6～12.5 kg.术后均使用呼吸机辅助呼吸,呼吸机使用时间(36.5±10.6)h.术后均使用一氧化氮气体吸入.术前详细评估,术后重点观察预防呼吸机相关性肺炎的发生,控制肺动脉压力.结果 110例患儿监护室停留时间为(3.2±24)d,均未发生呼吸机相关性肺炎及肺动脉高压危象.平均住院时间19.4 d,均顺利出院.结论 复杂先天性心脏病伴肺动脉高压的患儿做好围手术期呼吸道的管理能有效改善患儿的呼吸功能,减少ICU停留时间.危重患儿特别是伴有肺动脉高压患儿围手术期降低肺动脉压力,术后积极预防呼吸机相关性肺炎是患儿快速恢复呼吸功能的关键.     

先天性心脏病合并重度肺动脉高压围术期的护理

总结30例先天性心脏病合并重度肺动脉高压患者加强围手术期护理，术前护理的要点是心理护理、积极控制呼吸道感染、降低肺动脉压力；术后护理的要点是：呼吸管理、胸部体疗、肺动脉高压危象的观察、循环系统监测和防治感染。认为做好精心的围术期护理是促进先天性心脏病合并重度肺动脉高血病人早日康复的重要保证。     

牛心包补片修补心脏缺损并雾化吸入伊洛前列环素降低肺动脉高压

背景：对于先天性心脏病合并肺动脉高压的治疗,传统降低肺动脉高压的药物效果确实,但存在不易监测、停药后反跳等现象;传统的心脏涤纶补片较易引起吻合口变形、血栓、栓塞、溶血和感染等并发症。目的：观察应用戊二醛处理牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压的效果。方法：选择90例先天性心脏病合并肺动脉高压患者,术中采用戊二醛处理的牛心包补片修补心脏间隔缺损,术后雾化吸入伊洛前列环素30 ng/（min·kg）,日间12 h按1次/4 h给药,夜间12 h按1次/6 h给药,连续给药2 d。记录每次吸入药物前、吸入后即刻、吸入30 min后平均动脉压、平均肺动脉压、体循环阻力指数与肺循环阻力指数,于随访期观察有无心包材料相关并发症和心功能情况。结果与结论：90例患者复查超声心动图见活瓣均已关闭,无分流,心脏间隔缺损无回声中断,心脏收缩功能正常,未发现与牛心包补片相关的不良反应。所有患者不同时间点平均动脉压、体循环阻力指数比较差异无显著性意义。患者吸入药物后即刻平均肺动脉压、肺循环阻力指数明显低于吸入药物前（P 〈0.01）,吸入30 min后平均肺动脉压、肺循环阻力指数亦明显低于吸入药物前（P 〈0.05）。表明应用戊二醛处理的牛心包补片和雾化吸入伊洛前列环素治疗先天性心脏病合并肺动脉高压安全、有效。     

Heart valve disease in women in the reproductive age

About 1% of pregnant women have concomitant cardiac disease. An understanding of the impact of the physiologic changes associated with pregnancy upon structural cardiac disease is essential for proper counseling and management of these complex patients, which should be treated in a specialized team with experience in congenital as well adult disease. The availability of echocardiography provides information about disease aetiology, accurate and non invasive assessment of severity and means of monitoring progression. Contraindication for pregnancies still remain severe pulmonary artery hypertension and Eisenmenger-syndrome and severe surgical non corrected cyanotic disease as well. Postrheumatic stenosis, even when previously asymptomatic, can lead to pulmonary edema. Although pregnancies with asymptomatic regurgitant lesions are better tolerated. The best procedure in severe aortic insufficiency still remains controversial. Patients with Marfan syndrome and aortic root dilatation are at risk for aortic dissection and are difficult to manage. In patients with artificial valves continuing anticoagulation with warfarin is proposed in Europe. Due to accelerated valve deterioration during pregnancy the use of bioprotheses in women who need valvular heart surgery before pregnancy necessitate later valve replacement again and perhaps an autograft or homograft could be an alternate approach. Bacterial endocarditis in pregnancy shows a low incidence and is often associated with prior history of rheumatic or congenital heart disease. Therefore prophylaxis is recommended. There is an increase in the incidence of congenital heart disease among the offsprings of affected parents. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of severe form of congenital heart disease.     

Impact of respiratory syncytial virus infection on surgery for congenital heart disease: postoperative course and outcome.

OBJECTIVES: a) To describe the postoperative course and outcome of cardiac surgery in children with recent respiratory syncytial virus (RSV) infection; and b) to evaluate whether timing of surgery has any impact on the outcome. DESIGN: Retrospective case series. SETTING: Intensive care unit and medical and surgical wards of a teaching pediatric hospital. PATIENTS: Twenty-five children (aged 25 days to 3.5 yrs; median, 4 months) with congenital heart disease who had cardiac surgery within 6 months after RSV infection. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We reviewed the clinical course and outcome of all patients. The cardiac diagnoses included ventricular septal defect (n = 11), tetralogy of Fallot (n = 3), atrioventricular canal (n = 3), and others (n = 8). Thirteen patients had surgery during the same admission as RSV infection (group I), and 12 patients had surgery electively after being discharged to home after RSV infection (group II). Two patients in group I died; both of these patients had undergone total repair of tetralogy of Fallot within 2 wks after admission for RSV infection. Postoperative complications in group I patients included pulmonary hypertension (n = 5), adult respiratory distress syndrome (n = 1), tracheal stenosis (n = 1), left ventricular dysfunction (n = 1), pericardial effusion (n = 1), secondary bacterial or fungal infection (n = 7), and deep venous thrombosis (n = 1). Of all group I patients, the ones who were operated on early appeared to be at higher risk for complications, especially for postoperative pulmonary hypertension. No patient in group II died, and only two patients had minor complications (one had reactive airway disease, and the other had a transient superior vena cava syndrome after a bidirectional Glenn operation). CONCLUSIONS: Cardiac surgery performed during the symptomatic period of RSV infection is associated with a high risk of postoperative complications, especially postoperative pulmonary hypertension. These complications appeared to be more frequent and of greater severity in patients who had earlier surgery compared with those who had later surgery. More studies are needed regarding the proper timing of cardiac surgery in patients with congenital heart disease and RSV infection.     

先天性心脏病合并肺动脉高压13例术后监护

目的：探讨先天性心脏病合并肺动脉高压术后的监护方法。方法：对13例先天性心脏病合并肺动脉高压患儿的护理进行回顾分析。结果：患儿恢复良好。结论：耐心、细致、周到、科学的护理是保证先天性心脏病合并肺动脉高压患儿术后顺利康复的重要环节之一。     

小儿先心病心内直视术后早期死亡原因分析及对策

本文对713例小儿先心病心内直视术后早期死亡的原因进行了回顾性分析。术后死亡37例。低心排血量综合征、呼吸窘迫综合征和严重室性心律失常是导致术后早期死亡的主要原因。作者就防止或减少这类手术合并症的处理对策进行了讨论。     

Comparison of hyperventilation and inhaled nitric oxide for pulmonary hypertension after repair of congenital heart disease

BACKGROUND: Pulmonary hypertension is associated with congenital heart lesions with increased pulmonary blood flow. Acute increases in pulmonary vascular resistance (PVR) occur in the postoperative period after repair of these defects. These increases in PVR can be ablated by inducing an alkalosis with hyperventilation (HV) or bicarbonate therapy. Studies have shown that these patients also respond to inhaled nitric oxide (iNO), but uncertainty exists over the relative merits and undesirable effects of HV and iNO. HYPOTHESIS: Alkalosis and iNO are equally effective in reducing PVR and pulmonary artery pressure (PAP) in children with pulmonary hypertension after open heart surgery. SETTING: Critical care unit of a tertiary care pediatric hospital. DESIGN: Prospective, randomized, crossover design. PATIENTS: Twelve children with a mean PAP > 25 mm Hg at normal pH after biventricular repair of congenital heart disease. INTERVENTIONS: Patients were assigned to receive iNO or HV (pH > 7.5) in random order, and the effect on hemodynamics was measured. Each treatment was administered for 30 mins with a 30-min washout period between treatments. Finally, both treatments were administered together to look for a possible additive effect. MEASUREMENTS AND MAIN RESULTS: Cardiac output and derived hemodynamic parameters using the dye dilution technique. Hyperventilation, achieved by an increase in ventilator rate without a change in mean airway pressure, decreased Pa(CO2) from a mean (SD) of 43.7+/-5.3 to 32.3+/-5.4 mm Hg and increased pH from 7.40+/-0.04 to 7.50+/-0.03. This significantly altered both pulmonary and systemic hemodynamics with a reduction in PAP, PVR, central venous pressure, and cardiac output and an increase in systemic vascular resistance. In comparison, iNO selectively reduced PAP and PVR only. The reduction in PVR was comparable between treatments, although addition of iNO to HV resulted in a small additional reduction in PVR. An additional decrease in PAP was seen when HV was added to iNO, attributable to a reduction in cardiac output rather than a further decrease in PVR. CONCLUSIONS: Inhaled NO and HV are both effective at lowering PAP and PVR in children with pulmonary hypertension after repair of congenital heart disease. The selective action of iNO on the pulmonary circulation offers advantages over HV because a decrease in cardiac output and an increase in SVR are undesirable in the postoperative period.     

Update on complications of pediatric cardiac surgery

Management of the pediatric patient after congenital heart disease surgery requires a multidisciplinary team approach. All members of the team must understand the risk factors, pathophysiology, and management of common postoperative problems such as low cardiac output, pulmonary hypertension, and chylothorax to assure early recognition and intervention.     

先天性心脏病伴重度肺动脉高压术后早期并发症分析

目的 探讨先天性心脏病（CHD）伴重度肺动脉高压（PH）体外循环（CPB）术后早期并发症及处理。方法对本科2003年6月至2009年6月行CPB手术的45例CHD伴重度PH患者进行回顾分析,讨论术后早期主要并发症和死亡原因。结果术后早期主要并发症有严重低氧血症（13．33％）、缺氧发作（11．11％）、低心排（6．67％）。住院死亡率6．67％,死亡原因均为低心排,主要为右心室功能失代偿。多因素分析显示,低温CPB（OR=0．56;95％CI0．35-0．89）是严重低氧血症的一个危险因素。结论术后早期并发症主要由术后PH为基础的心肺功能不全所导致,对术后高危患者动态监测肺动脉压、右心功能和延长呼吸机支持,有助于防治并发症。     

先天性心脏病合并肺动脉高压患者介入手术围术期的护理

目的总结和分析先天性心脏病合并肺动脉高压患者介入手术围术期的护理要点。方法手术前后进行心理疏导,做好术前准备;术后严密监测患者肺动脉高压和生命体征的变化情况,做好并发症的观察及预防和输液管理。结果本组18例患者术后均康复出院,未出现严重并发症。结论围术期良好的护理是保证先天性心脏病合并肺动脉高压患者治疗效果和减少术后并发症的重要环节。     

1岁以内室间隔缺损并肺动脉高压病儿的外科治疗及围术期管理

目的 总结1岁以内室间隔缺损并肺动脉高压病儿的外科治疗和围术期处理的经验.方法 2006年11月-2009年8月,我科共手术治疗1岁以内室间隔缺损并肺动脉高压病儿41例.全组病例均在浅低温或低温体外循环下行畸形矫治术.结果 本组病儿无死亡.主要并发症有肺动脉高压危象、低心排血量综合征、肺不张、张力性气胸、出血、呼吸机相关性肺炎、血源性感染等.术后SaO2为93%～98%.随访6～24个月,病儿心功能较术前明显改善.结论 肺动脉高压危象和低心排血量综合征是先天性心脏病并肺动脉高压病儿术后的主要并发症.早期手术及良好的围术期处理是提高病儿生存率的关键.