氯胺酮复合丙泊酚和芬太尼用于小儿心导管术麻醉的前瞻性随机研究

目的 评价静脉氯胺酮复合丙泊酚和芬太尼用于右向左分流心脏病患儿心导管介入手术麻醉的安全性和有效性.方法 50例右向左分流心脏病患儿施行心导管术,随机分为两组（25例）：氯胺酮＋丙泊酚和氯胺酮＋芬太尼组.观察和记录术中血流动力学、氧合和术后恢复各项指标及副作用.结果 两组患儿年龄、性别和麻醉时间差异无统计学意义.氯胺酮＋丙泊酚组平均动脉压、体循环血管阻力和肺/体循环血管阻力比值明显降低,而氯胺酮＋芬太尼组麻醉后动脉血氧饱和度和血氧分压明显高于氯胺酮＋丙泊酚组;术后完全恢复时间,氯胺酮＋芬太尼组明显长于氯胺酮＋丙泊酚组.结论 氯胺酮复合芬太尼用于右向左分流心脏病患儿施行心导管术的麻醉,相比氯胺酮复合丙泊酚麻醉更为安全、有效.     

右美托咪定滴鼻镇静用于先天性心脏病患儿介入封堵手术的研究

目的:探讨先天性心脏病患儿介入封堵手术应用右美托咪定术前滴鼻镇静,再复合静脉麻醉对围术期影响。方法:选取行介入封堵手术的先天性心脏病患儿60例,随机分成滴鼻组(N组)和对照组(B组)。麻醉诱导前30 min N组给予右美托咪定1.5μg/kg滴鼻镇静,B组给予等量0.9%氯化钠液。记录滴鼻即刻、滴鼻后10 min、滴鼻后30 min、手术开始时及手术结束后10 min患儿的MAP、HR;镇静程度评分;手术时间、苏醒时间及丙泊酚的总用量;术后10 min、术后30 min及术后60 min患儿麻醉苏醒期躁动评分;不良反应的发生率。结果:术中N组丙泊酚用量低于B组(P0.05)。两组在各时间点HR,MAP差异无统计学意义(P0.05)。N组患儿与家长分离时镇静评分高于B组(P0.05)。N组在术后10 min,30 min的躁动评分均低于B组(P0.05)。结论:先天性心脏病患儿介入封堵手术应用右美托咪定术前滴鼻镇静,再复合静脉麻醉可减轻患儿术前焦虑,增强麻醉效果,减少术中丙泊酚的用量,同时可减轻小儿术后躁动,使苏醒过程更加平稳。     

小儿复杂先天性心脏病手术中的护理体会

目的分析小儿复杂先天性心脏病手术中的护理方法与效果。方法回顾性分析24例小儿复杂先天性心脏病手术患儿的临床资料,总结术中护理方法与效果。结果 24例小儿复杂先天性心脏病手术患儿经过术中积极的配合与护理后,存活24例,百分比100%。结论针对小儿复杂先天性心脏病手术患儿,术中给予积极的配合与护理,能提高患儿存活率,值得推广。     

重症先天性心脏病患儿心导管及造影检查时的麻醉——369例总结

目的介绍小儿重症先天性心脏病(先心病)患儿心导管及造影检查时的麻醉体会。 方法选择369例先心病施行心导管或左右心室造影检查的患儿，其中左向右分流合并重度肺动脉高压86例，肺动脉瓣狭窄和原发性肺动脉高压11例，右向左分流复杂畸形272例。麻醉前常规禁食。入室后监测外周血氧饱和度、心电图及血压，记录基础值。患儿面罩吸氧，建立静脉通路后，静脉注射东莨菪碱0.02mg/kg、氯胺酮1～2mg/kg。待患儿意识消失后肌肉注射氯胺酮6～8mg/kg+氟哌啶0.15～0.30mg/kg维持，或间断静脉注射氯胺酮1～2mg/kg加深麻醉。 结果术中经过基本顺利。全组共18例出现不同程度腹胀、呕吐、呛咳、心律失常、顽固性缺氧等并发症，发生率4.88%，其中1例死亡，死亡率0.27%。 结论小儿重症先心病行心导管及心血管造影检查时，麻醉有其特殊性。要求麻醉医师掌握心脏病的病理生理，充分给氧，保持呼吸道通畅，防止胃返流、误吸的发生，充分镇静，术后继续吸氧并监测血氧饱和度，尽可能避免并发症的发生。     

儿童先天性心脏病介入术中监护及并发症的处理

目的总结儿童先天性心脏病介入诊疗术中的监护经验与并发症处理。方法回顾121例儿童先天性心脏病行导管介入术的监护资料,分析术中的并发症。结果术中出现并发症16例(13%,16/121),其中15例经及时处理症状消失,1例因心脏停搏抢救无效死亡。结论儿童先天性心脏病介入诊疗术中进行严密监护和及时处理并发症,是保证手术安全顺利进行的必要措施。     

儿童先天性心脏病介入治疗术后镇痛研究进展

介入手术治疗是目前先天性心脏病患儿常见的临床治疗方式之一，但术后不仅会加快患儿心率、增加血压和氧消耗量，而且因疼痛引起的咳嗽还会引起肺不张和低氧血症等并发症的发生，不利于患儿术后的康复，并严重影响患儿及其家长的生活质量。本文就儿童先天性心脏病介入治疗术后影响疼痛发生的因素、术后疼痛对机体的影响以及目前常用的术后镇痛的方法等进行文献综述     

小儿先天性心脏病室间隔缺损经导管介入治疗与外科手术治疗的对比分析

目的比较经导管介入治疗与外科手术治疗小儿先天性心脏病室间隔缺损的临床疗效。方法从2016年1月至2019年10月阶段在我院治疗的小儿先天性心脏病室间隔缺损患儿中选取80例,采取随机分组法将其分为介入组和外科组,每组40例。外科组患儿采取外科开胸手术进行治疗,介入组患儿采取经导管介入治疗。结果介入组患儿的手术成功率,与外科组患儿相当,比较差异没有统计学意义(P0.05);介入组患儿的手术时间显着短于外科组,术中输血量显着少于外科组,术后机械通气时间、术后ICU住院时间、总住院时间均显着短于外科组,比较差异有统计学意义(P0.05)。介入组患儿的心律失常发生率和新发瓣膜反流发生率,均显着低于外科组,比较差异有统计学意义(P0.05)。结论经导管介入治疗能够获得与外科手术治疗相当的治疗效果,且并发症发生率更低,术后康复更快,具有显着的应用优势。     

亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉临床效果观察

目的观察亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉的效果。方法将择期行腹部、四肢手术的60例患几分为三组,三组均用氯胺酮作基础麻醉,选20例行下肢、腹部手术患儿（A组）采用亚麻醉剂量氯胺酮＋芬太尼辅助椎管内麻醉,选20例行上肢手术患儿（B组）用亚麻醉剂量氯胺酮＋芬太尼辅助神经阻滞麻醉,另20例患儿（C组）单用氯胺酮麻醉,记录三组心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、脉搏氧饱和度（SpO2）、氯胺酮用量和追加次数、芬太尼用量、手术和唤醒时间、肌松状况及不良反应。结果A、B组HR、RR及SpO2水平较C组低,A、B组较C组苏醒时间短、不良反应发生率低、氯胺酮用量及追加次数较少,且肌松、止痛效果良好。结论与传统氯胺酮麻醉相比,亚麻醉剂量氯胺酮-芬太尼辅助小儿区域麻醉效果更好。     

静脉复合麻醉在小儿气管-支气管异物取出术中的应用

目的观察氯胺酮复合异丙酚麻醉在小儿气管-支气管异物取出术中的应用效果。方法选择53例气管异物小儿,采取氯胺酮、咪唑安定、异丙酚复合麻醉相结合,以支气管镜侧孔供氧,以保证患儿充分通气、供氧,确保患儿术中生命安全。结果所有患儿均安全完成手术,未发现喉痉挛等严重并发症。结论该麻醉方法是安全可行的气管-支气管异物取出术的麻醉方法。     

小儿麻醉中应用七氟烷吸入诱导与氯胺酮肌肉注射的比较

目的研究七氟烷吸入诱导与氯胺酮肌肉注射在小儿麻醉中的应用效果比较。方法抽取笔者所在医院2012年1月至2014年1月,已收治住院的患儿130例,作为研究对象。随机分为两组,七氟烷组和氯胺酮组,每组65例。七氟烷组患儿手术麻醉选择七氟烷吸入诱导,氯胺酮组患儿手术麻醉选择氯胺酮肌肉注射。分别记录两组患儿麻醉诱导时间、术后苏醒时间以及不良反应,对比分析数据。结果七氟烷组患儿手术前麻醉诱导时间为（16±5）s,术后麻醉苏醒时间为（13±4）min;氯胺酮组患儿手术前麻醉诱导时间为（368±79）s,术后麻醉苏醒时间为（102±26）min。七氟烷组的术前诱导时间和术后恢复时间明显比氯胺酮组的时间短,时间差异具有统计学意义（P〈0.05）。七氟烷组患儿共出现17例不良反应,不良反应率为26.2%,其中,2例（3.1%）嗜睡,15例（23.1%）不安,没有发生心脏功能变化和恶心呕吐不良反应;氯胺酮组患儿共出现22例不良反应,不良反应率为33.8%,其中,13例（20.0%）嗜睡,3例（4.6%）不安,1例（1.5%）心跳变化,5例（7.7%）恶心呕吐。七氟烷组总不良反应率低于氯胺酮组,除了不安比例高于氯胺酮组,其他不良反应均少于氯胺酮组,总的不良反应差异具有统计学意义（P〈0.05）。结论七氟烷吸入法诱导时间及苏醒时间短,不良反应少症状轻,在小儿麻醉手术中安全性和可行性高,值得在临床应用中推广。     

妊娠合并先天性心脏病患者剖宫产麻醉管理45例分析

目的:总结合并先天性心脏病(先心病)患者剖宫产的麻醉管理经验。方法:回顾性分析45例妊娠合并先心病患者剖宫产的临床资料。结果:本组44例患者采用了硬膜外阻滞麻醉,其中包括15例合并中、重度肺动脉高压(PH)或艾森曼格综合征的患者,均采用小剂量、分次及缓慢的硬膜外给药方法,维持循环平稳。仅1例重症患者采用全麻。术中完善监护措施,积极防治心力衰竭,所有产妇均平安度过围术期。结论:硬膜外阻滞麻醉适应于大多数合并先心病患者剖宫产手术,术前进行多科会诊,围术期积极防治心衰,密切监测、维持循环稳定是确保围产期母婴安全的关键。     

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??Abstract??Structural heart disease is a new subspecialty in cardiovascular field.It refers to anatomic heart or great vessels abnormalities by congenital or acquired factors.The majority of anatomical structure in congenital heart disease can be cured by interventional therapy. hybrid procedure combined with surgery and internal operation,transcatheter aortic valve implantation for aortic stenosis and transcatheter mitralvalve repair for mitral insufficiency have changed the traditional treatment model which show the wide prospects of interventional therapy of structural heart diseases.     

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??Abstract??The severity of congenital heart disease varies and how to select the appropriate timing and therapeutic approach is an important prerequisite to get the best efficacy and reduce the mortality.Percutaneous balloon pulmonic valvuloplasty is the first choice for the management of pulmonary valve stenosis in patients at any age.Either surgery or interventional therapy for aortic valve stenosis is as a palliative treatment in childhood.Percutaneous balloon aortic valvuloplasty or stent implantation is the therapeutic approach for coarctation of the aorta in patients during early childhood and adolescence.Congenital heart diseases with left to right shunt??which develop a significant pulmonary hypertension??need early interventional treatment or surgery.As for the complicated congenital heart diseases??how to determine the timing of surgery and to select surgical approach are based on pulmonary artery pressure??size of pulmonary artery and the existence of hypoxemia.     

先天性心脏病介入封堵未成功原因分析

目的：分析先天性心脏病（先心病）介入封堵治疗未成功原因及防治措施。方法：对206例3种常见先心病施行了介入封堵治疗．其中动脉导管未闭（PDA）封堵64例（PDA组）;房间隔缺损（ASD）封堵76例（ASD组）;室间隔缺损（VSD）封堵66例（VSD组）。对介入治疗未成功的7例作了回顾分析。结果：未成功率为3．40％（7／206）。其中PDA组为3．13％（2／64）,ASD组为2．63％（2／76）,VSD组为4．55％（3／66）。未成功原因是：对导管大小判断有误,放置封堵伞有误,输送鞘管引起迷走神经反射。结论：先心病介入封堵术是一种微创、有效的治疗措施,但影响手术成功的因素不容忽视。     

先天性心脏病介入治疗在外科术后的应用

目的:评价肺血减少性先天性心脏病(先心病)外科术后,补充性介入治疗的价值。方法:对我科2010年5月至2011年6月住院的15例患者,肺血减少性先心病外科根治或减状手术后的补充性介入治疗进行总结分析。男性10例,女性5例,年龄6个月～14岁,平均3.7岁。病种及外科手术方式包括法洛四联症根治术或减状术5例,右心室双出口Glenn术3例,肺动脉闭锁根治术3例,Glenn术1例,单心室Glenn术2例及共同动脉干根治术1例。介入治疗情况:1.体肺侧枝血管封堵术10例,其中因肺出血而急诊封堵术3例,体肺侧枝血管肺静脉瘘1例。2.因Glenn术后奇静脉扩张窃血、血氧饱和度下降行奇静脉封堵1例。3.外科术后肺动脉狭窄行狭窄部位球囊扩张术4例。结果:介入治疗达到预期效果,未发生与操作相关的并发症。结论:介入治疗可作为一些复杂先心病外科术后,有效的补充性治疗手段。     

Transcatheter interventions for multiple lesions in adults with congenital heart disease

Recent advances in diagnosis, surgery and interventional management have significantly changed the quality of life of patients with congenital heart disease. Historically, congenital heart disease patients with multiple cardiac lesions have been referred for surgery; however, with the advent of newer technologies and expertise, transcatheter treatment has evolved as an alternative option. A series of patients who underwent interventional procedures for multiple congenital heart disease lesions with excellent procedural and medium-term outcomes is reported.     

Magnetic resonance imaging guided cardiovascular interventions in congenital heart diseases

The purpose of this article is to present some recent applications of diagnostic and interventional MRI in congenital heart disease. To date x-ray-based techniques have been the norm for most diagnostic and therapeutic applications. With the advent of ultrafast MRI and the development of MRI-compatible catheters and guide wires, the goal of achieving real-time guidance by MRI for interventions in congenital heart diseases has proven feasible. We briefly review the latest advances in cardiovascular MRI, and the development of MR-compatible devices for diagnostic and therapeutic applications such as ASD closure and pulmonary artery dilation.     

Transfer of cardiac catheterisation from a paediatric to an adult cardiological centre: results at 3 years

The advances of surgical and interventional treatment of congenital heart diseases have allowed a large number of patients with congenital heart disease to reach adult age. This population involves almost 0.3/1000 of total population in West Europe and North America and can be estimated around 200000 patients in France. Patients with operated Tetralogy of Fallot, benign forms of pulmonary atresia with ventricular septal defect, simple or complex transposition of the great arteries usually survive beyond childhood. These patients can need repeated interventions to treat lesions of native or reconstructed pulmonary arteries and/or aortic arch, to occlude residual shunts, to treat pulmonary incompetence. More complex heart diseases such as single ventricle, rarely allow survival until the adult age. The majority of these patients undergo heart transplant, often made difficult by multiple cardiac surgeries, anomalies of pulmonary arteries, chronic cyanosis, aorto-pulmonary shunts. Patients with relatively simple or complex congenital heart diseases need to be followed-up in specialized units, like those created more than twenty years ago in the United States, Canada, and United Kingdom. Interventional cardiac catheterisation play a major role in the management of this population. The results of 3 years of activity in a new centre treating GUCH patients are illustrated.     

Herzinsuffizienz im Kindesalter

BACKGROUND: In contrast to the adult age group epidemiologic studies on congestive heart failure (CHF) in infancy and childhood are lacking. METHODS: Retrospective study of all patients admitted to the University Children's Hospital Essen, Germany, between 1989 and 1998 with the ICD 9 code for congenital and acquired heart diseases, cardiomyopathies, arrhythmias, arterial und pulmonary hypertension, and other cardiovascular anomalies. CHF was defined by the typical symptoms, start and end of CHF by commencement and end of anticongestive therapy (ACE inhibitors and/or diuretics and/or digoxin). Prevalence and incidence of CHF were determined and related to all patients with congenital and acquired heart diseases and to all general pediatric inpatients at the Children's Hospital from 1989 to 1998. Within 10 years 1,755 children with heart diseases were admitted, 918 boys and 837 girls. 1,297 children suffered from congenital heart diseases, 167 from rhythm disturbances, 110 from cardiomyopathies and acquired heart diseases, while prematures and patients with systemic or pulmonary hypertension are not furthermore topic of this study. RESULTS: CHF occurred in 587 (33.4%) out of 1,755 children with all congenital and acquired heart diseases, and in 507 (39.1%) out of 1,297 children with congenital heart defects (CHD). When postoperative CHF was excluded, CHF occurred in 23.7% of children with CHD. Cumulative incidence of CHF was 334 out of 1,000 patients with all heart diseases and 233 out of 1,000 general pediatric inpatients. For patients with CHD the incidence of CHF was 289 out of 1,000 patients with all heart diseases and 20.1 out of 1,000 general pediatric inpatients. Prevalence of CHF for children with heart diseases was 279 in 1,000 and 17.3 in 1,000 general pediatric inpatients, for children with CHD 261 in 1,000 and 16.1 in 1,000 general pediatric inpatients. CHF occurred in 70.6% during the 1st year of life and lasted for a mean of 15 months. Only in patients with cardiomyopathies and acquired heart diseases the incidence in infancy was not so pronounced. In 78% of patients with CHD CHF ends after an operation. Mortality: during the 10-year interval 111 out of 1,755 patients with heart diseases died, 81 of them for CHF. That gives an overall mortality of 6.3%, 18% following heart surgery or cardiac catheterization, 74% with signs of CHF. In patients with CHD mortality was 6.2%. Out of the 587 children with CHF, 81 (14%) died. 67% of deaths occurred during the 1st year of life, in patients with CHD even in 71%. CONCLUSION: CHF is uncommon in infants and children with congenital or acquired heart disease, but has considerable mortality. As surgical or interventional therapy is well established in nearly all patients with CHD, prognosis is much better compared to adults. A prospective evaluation by a nationwide registry is necessary.     

New Directives in Cardiac Imaging: Imaging the Adult With Congenital Heart Disease

Advances in pediatric surgical and interventional techniques and medical care over the past 50 years have revolutionized the care of children with congenital heart disease. Survival to adulthood is now expected and, as such, there is a growing population of adults which is exceeding the pediatric population with congenital heart disease. Noninvasive cardiac imaging with modalities such as echocardiography, computed tomography, and cardiac magnetic resonance imaging are integral to the care of adults with congenital heart disease. These modalities are used for diagnosis, surveillance for complications late after surgery and catheter-based interventions, and in decision-making for medical, interventional, and surgical therapies. In this review we will discuss noninvasive imaging modalities used to assess congenital cardiac lesions, imaging strategies for select congenital lesions, and comment on the future of cardiac imaging in congenital heart disease.