膈肌折叠在先天性心脏病术后膈肌麻痹中的应用

目的：总结膈肌折叠在先心病术后膈肌麻痹患儿中应用的临床经验,评价其有效性。方法：2007年6月至2008年6月,8例先心病患儿发生膈肌麻痹,不能脱离呼吸机辅助或是脱机后有严重呼吸困难,行膈肌折叠术。结果：经膈肌折叠后,所有患儿均顺利脱离呼吸机辅助,治愈出院。结论：6个月的先心病患儿术后发生膈肌麻痹时,常常难以顺利脱离呼吸机;膈肌折叠是非常安全、简便的治疗手段。     

先天性心脏病心脏直视术后膈肌麻痹的诊断与外科治疗

目的:探讨先天性心脏病(CHD)心脏直视术后并发膈肌麻痹(DP)的诊断、病因与膈肌折叠术(DPP)的适应证及术后效果。方法:回顾性分析2010年1月至2019年3月,安贞医院小儿心脏中心,CHD术后因DP行膈肌折叠手术13例患儿的临床资料。其中男性7例,女性6例,患儿中位手术年龄3(1,105)个月,中位体质量5.1(4.1,34)kg,心脏直视手术术后中位天数20(5,42)d接受DPP术,其中行单侧DPP术10例,左侧3例,右侧7例;行双侧DPP术3例;行CHD根治手术8例,其中完全性肺静脉异位引流(心上型)3例,室间隔完整的肺动脉闭锁3例,合并室间隔缺损的主动脉弓离断1例,合并室间隔缺损的主动脉弓缩窄1例;姑息手术5例,包括上腔静脉右肺动脉吻合术(Gleen)2例,升主动脉主-肺动脉人工血管吻合术(B-T)2例,肺动脉环缩术(PAB)1例。CHD术后均不能脱离呼吸机辅助或脱机后有严重呼吸困难,多次气管插管,经胸X线片和/或B超确断。结果:住院死亡2例,均死于全身感染、感染中毒性休克死亡。ICU中位滞留时间54(2,106)d,中位住院时间65(29,159)d。余11例患儿心肺功能得到恢复,顺利脱离呼吸机。随访9例,中位随访时间26.2(1,62)个月,胸X线检查膈肌位置正常。结论:先心病患儿术后发生膈肌麻痹时,经胸DPP术是安全有效的治疗方法,术中预防是避免发生的关键。     

射频消融治疗先天性心脏病修补术后心房扑动2例

例1,男, 32岁,因先天性心脏病房间隔缺损修补术后感心悸20 d入院.心电图示心房扑动2 ∶1下传,心率125次/min,修补术前心电图为窦性心律.心脏B超示左房内径(LA)30 mm,左室内径(LV)48 mm.     

小儿先天性心脏病75例介入治疗护理体会

目的探讨小儿先天性心脏病介入治疗中的护理经验。方法回顾性分析75例小儿先天性心脏病介入治疗的临床护理经过及效果。结果75例患儿均取得满意的效果。术后第3天再次行超声心动图检查均显示无残留分流,心脏听诊无杂音,手术成功率100%(75/75)。术后出现房室传导阻滞1例,溶血1例,穿刺部位血肿1例,经相应处理后均愈痊。住院天数5 d～7 d,中位住院天数为5 d。术后随诊观察未发生封堵器移位和再通。结论采取充分的术前护理,正确的术中配合,解除患儿及家属的精神压力和心理负担,密切的术后病情观察及护理,预防和减少并发症的发生,详细的出院指导,是小儿先天性心脏病介入治疗取得满意疗效的保证。     

先天性心脏病介入治疗术后在ICU的护理

目的探讨小儿先天性心脏病介入治疗后在综合ICU的护理特点。方法对近2年来泸洲医学院附属医院儿科、心内科及心胸外科行小儿先天性心脏病介入治疗后进入综合ICU的208例患儿的护理特点和重点操作内容进行分析和总结。结果所有在介入术后进入ICU的患儿均接受了有较强针对性的加强护理,在ICU的观察时间为6～8 h,仅5例发生较轻心律失常,均顺利转出ICU。结论小儿先天性心脏病介入治疗后在综合ICU给予有针对性的加强护理,既可减轻患儿的痛苦,又能减少术后并发症,提高手术的安全性和成功率。     

小儿先天性心脏病护理中的健康教育

目的 探讨专职护理健康教育模式在小儿先天性心脏病护理工作中的方法与效果.方法 选择我院自2011年1月收治的小儿先天性心脏病患者105例,对其实施专职护理健康教育,具体方式是对患儿及家长进行入院至出院全程的健康教育,内容重点是治疗解释,生活安全知识、饮食指导、用药指导等;对实施专职护理健康教育模式前后的患儿家长分别进行疾病相关知识的知晓情况调查,对结果进行对比分析.结果 实施专职护理健康教育模式后,患儿家长在小儿先天性心脏病相关知识的各方面熟悉度均明显提高,两组比较差异有统计学意义(P＜0.05).结论 实施专职护理健康教育模式有助于提高患儿家长对疾病相关知识的熟悉度,提高治疗效果,值得推广应用.     

先天性心脏病介入封堵治疗的护理研究

目的探讨先天性心脏病介入封堵治疗的护理措施。方法回顾性分析51例先天性心脏病介入封堵治疗患者的临床资料。结果 51例先天性心脏病患者实施封堵,手术成功率100%。结论加强先天性心脏病患者介入封堵治疗的护理,是介入治疗获得成功的重要保证。     

成人先天性心脏病术后肺动脉高压危象的预防和护理

目的总结407例成人先天性心脏病合并肺动脉高压患者术后肺动脉高压危象的预防措施和护理方法。方法术后采取有效镇静、镇痛;持续监测肺动脉压、肺动脉收缩压与体动脉收缩压比值、心指数、血氧饱和度等血流动力学指标;维护心功能、预防低心排血量综合征;加强呼吸管理,保证充分供氧,预防呼吸道感染及使用靶向药物治疗。结果全组患者术后发生肺动脉高压危象13例,主要因肺动脉高压危象导致死亡的2例。结论肺动脉高压危象的治疗关键在于预防。术后充分评估病情,实施针对性的护理措施,能有效预防肺动脉高压危象的发生。     

婴幼儿先天性心脏病术后并发症的临床分析

目的:探讨婴幼儿先天性心脏病术后的常见并发症及防治措施。方法:收集2003~2004年年龄2个月~3岁的病例295例,总结分析其术后并发症。结果:死亡原因以低心排血量综合征为多见,另外依次是急性肾功能衰竭、心律失常、呼吸功能衰竭等。并发症中占第一位的也是低心排血量综合征,共19例,另外依次是肺部并发症、心律失常、急性肾功能衰竭、神经系统并发症等。结论:掌握好手术指征,尽量缩短手术时间,同时提高体外循环水平,加强围术期的监护是减少婴幼儿术后并发症的关键。     

120例先天性心脏病术后心律失常的分析

目的：探讨先天性心脏病心脏直视术后心律失常的发生情况。方法：120例先天性心脏病患者(室间隔缺损86例，房间隔缺损34例)在心脏直视缺损修补术后转入监护室持续心电监护，随时描记标准12导联心电图，了解发生心律失常的类型及预后。结果：59．2％(67／120)的患者术后发生心律失常，其中室缺修补术后发生心律失常的患者占47．5％，以右柬支传导阻滞为主；房缺修补术后发生心律失常的患者14例，占34例的41％，以阵发性室上速和右柬支传导阻滞为主。结论：先心病手术后发生心律失常的情况与缺损部位，手术方式、路径及术后血流动力学的稳定状况有极大的关系。     

Ultrasound in the diagnosis of diaphragmatic paralysis after operation for congenital heart disease

Phrenic nerve palsy is a recognised complication of operation for congenital heart disease in children. The accuracy of ultrasound in assessing diaphragmatic motion was prospectively compared with fluoroscopy in 16 patients in whom phrenic nerve palsy was suspected. Ultrasound successfully identified the five patients with phrenic nerve palsy; there were no false positive or false negative diagnoses. Ultrasound was as effective as fluoroscopy in the diagnosis of abnormalities of diaphragmatic motion.     

Ultrasound in the diagnosis of diaphragmatic paralysis after operation for congenital heart disease.

Phrenic nerve palsy is a recognised complication of operation for congenital heart disease in children. The accuracy of ultrasound in assessing diaphragmatic motion was prospectively compared with fluoroscopy in 16 patients in whom phrenic nerve palsy was suspected. Ultrasound successfully identified the five patients with phrenic nerve palsy; there were no false positive or false negative diagnoses. Ultrasound was as effective as fluoroscopy in the diagnosis of abnormalities of diaphragmatic motion.     

Arrhythmias in patients with congenital heart disease

Improved surgical outcome for patients with congenital heart disease (CHD) has created a rapidly expanding population of adolescents and young adult survivors. Cardiac arrhythmias are a common late sequelae of this form of heart disease. Effective treatment requires clear understanding of the underlying anatomic defect as well as the specific surgical interventions. Intraatrial reentrant tachycardia (IART) is the most common and difficult arrhythmia encountered in these patients. Traditional IART treatment with medication has been largely unsuccessful, but radiofrequency ablation has emerged in recent years as a promising option for many patients. The availability of three-dimensional mapping systems and irrigated-tip ablation catheters has improved acute success rates for IART to better than 90%. Postablation recurrence of IART still remains problematic for patients who have undergone the Fontan operation, in which case atrial maze surgery may be considered. Ventricular tachycardia (VT) is seen in a smaller number of CHD patients, most notably those with tetralogy of Fallot or aortic stenosis. The adoption of implantable defibrillator (ICD) therapy for these patients has improved outcome. Owing to their complex anatomy, the CHD population presents unique challenges during both catheterization and device implant. Multicenter study of this unique patient group is needed in order to develop more objective treatment guidelines.     

复杂型先天性心脏病围术期体-肺侧支堵闭术的护理

目的总结复杂型先天性心脏病围手术期体-肺侧支堵闭术的护理方法。方法回顾性分析11例接受经皮体-肺侧支堵闭术患儿的临床资料,着重分析护理方法。结果 11例患儿中除1例出现严重低血氧外,其余无严重并发症发生,安全渡过围手术期。结论为了保证手术的成功,术前要做好评估及充分的术前准备,术后密切监测血氧饱和度、心律、心率、血压的改变,发现异常及时处理是围术期护理的关键。     

Bilateral diaphragmatic paralysis in association with neurogenic disease.

A patient had complete diaphragmatic paralysis and his disease progressed to include systemic neurological deficit. The cause is unknown. Appropriate diagnostic tests are emphasized, and a discussion of potential etiologies with a review of the literature of idiopathic diaphragmatic paralysis is presented.     

肺动脉高压合并小缺损先天性心脏病的认识与研究进展

先天性心脏病（先心病,CHD）在活产婴儿中的发病率约为8／1000,而30％未接受手术矫形的CHD患者会出现肺血管疾病,其中很大一部分将发展为不同程度的肺动脉高压（PAH）。目前随着CHD患者存活到成人的人数增加,成人先心病患者中肺动脉高压患病率约为5％～10％,并呈现随年龄增长的增高趋势,尤其是在房间隔缺损患者中。     

先天性心脏病复合畸形的介入治疗

先天性心脏病（先心病）复合畸形是指同一患者同时有两种或两种以上心血管畸形并存的先心病。近年来，随着先心病介入治疗器材的改进及介入治疗技术的提高．某些单一型先心病介入治疗的临床疗效与安全性已得到公认，并在此基础上逐渐开展了对先心病复合畸形同期进行介入治疗技术。     

Diastolic dysfunction in patients with congenital heart disease

As noted in the introduction of this article, a comprehensive evaluation of diastolic function in all known congenital heart defects is not feasible; however, by demonstrating several representative anatomic and genetic abnormalities where diastolic dysfunction may have clinical significance, it is hoped that scaffolding has been established which will provide structure for further study on this intriguing and influential component of function in patients with CHD. Understanding the contribution of diastole to overall ventricular function may be shown to have important implications in the recommendations for timing or potential benefit of surgical intervention. Or, to state differently, if diastolic dysfunction precedes that of systolic, would a rigorous analysis of diastole in the presurgical patient provide a more sensitive algorithm for intervention? The means for noninvasive assessment of diastolic function, primarily by spectral Doppler echocardiography, or using echocardiography in conjunction with other modalities, should allow for a comprehensive accrual of data in this patient population.