30064例住院患儿中心跳呼吸骤停及心肺脑复苏的调查

本文对３０，０６４例住院患儿进行了心跳呼吸骤停和复苏措施的调查。系统总结了小儿发生心跳呼吸骤停的临床特点，发现年龄愈小其发生率愈高，原发疾病以感染多见（占８４．５５％），窒息是发生骤停的主要直接因素，多为缺氧后极缓窦律而停搏，即时存活较成人高但常可反复骤停，复苏后体温不升、脑水肿、呼吸循环功能不全和严重腹胀较易发生。通过比较发现气道通畅是复苏的关键，宜道选肾上腺素静脉注射，而心内注射和联用‘三联针     

从21例小儿院前呼吸心跳骤停谈基层院前急救

随着急救复苏水平提高,院内小儿心肺复苏成功率明显增高,但对小儿院前呼吸心跳骤停的抢救仍不力,以致不少患儿失去抢救时机而死亡。本文通过对21例小儿院前呼吸心跳骤停及其抢救情况分析,就目前基层医院小儿急救存在问题及如何加强此项工作进行探讨。     

小儿心肺复苏(综述)

心、肺复苏(心跳呼吸停止后的抢救)已有上千年的历史。然而近代医学复苏术的历史并不久,约一百年前开始开胸直接心脏按压法,使复苏效果为之一新。1960年首次成功地应用胸外心脏按压术后,复苏对象不再局限于外科手术台上的病人,普通病房乃至各种现场上的许多心跳、呼吸骤停患者经过及时胸外心脏按压得以复生。现在心、肺复苏术已广为应用,复苏的技术不断改进,复苏所用器械不断完善,复苏的知识正在普及到广大群众。许多因素促使小儿时期心跳、呼吸骤停的发生率相对地比成人高,复苏的成功率也相应     

小儿心内直视手术探讨

目的 探讨基层医院开展小儿心内直视手术的经验和教训。方法 自1996年初至2001年5月对103例小儿先天性心脏病行心内直视手术，其中房缺修补25例、室缺修补62例、部分房室管畸形矫治5例、法乐氏四联症根治5例、肺动脉瓣切开4例，其它2例。结果 术后心脏自动复跳65例，电击复跳23例，心脏未停跳15例；术后并发症：出血2例，心包填塞1例，心律失常1例；术后死亡3例。结论 掌握好适应症，选择合适的病例，加强术前、术中及术后各个环节的处理，增强医护人员责任心，基层医院开展小儿心内直视手术还是切实可行的。     

小儿心内直视手术后上消化道出血的急救

小儿心内直视手术后上消化道出血的急救中国医科大学第二临床学院（１１０００３）王文生，郑有仁小儿心内直视手术后并发上消化道出血虽然较为少见，但其临床经过凶险，死亡率较高［１］。１９９３年～１９９４年间我院共有３例先天性心脏病患儿于体外循环术后并发上消化...     

小儿心内直视手术后急性呼吸窘迫综合征的危险因素与防治对策

目的 分析小儿心内直视手术后发生急性呼吸窘迫综合征(ARDS)的危险因素及探讨其防治对策.方法 以2001年1月至2008年10月间连续1 408例施行先天性心脏病(先心病)手术患儿为研究对象,进行术后ARDS危险因素的单因素分析和多因素Logistic回归分析.结果 术后发生ARDS 32例,发生率为2.27%.术后ARDS患儿病死率为46.9%.单因素分析显示:紫绀型先心病、体外循环时同、主动脉阻断时间、呼吸机通气时间、每公斤体质量引流液总量、围手术期意外、术后并发症与术后ARDS有关.经多因素Logistic回归分析显示:体外循环时间超过180 min、每公斤体质量引流液总量超过18 ml、围术期发生意外、术后多器官功能衰竭为小儿心内直视手术后ARDS的危险因素.结论 对于具有ARDS高危因素的心内直视手术患儿,应采取积极的防治措施,这对防止心内直视手术后发生的ARDS具有重要的意义.     

小儿心内直视手术围术期心律失常的原因及防治

目的探讨小儿心内直视手术后心律失常发生原因及防治措施。方法对310例小儿心内直视术后出现心律失常情况进行回顾性分析。激动起源异常275例（88.7%）,针对病因诱因简单处理,使用常规抗心律失常药物即奏效。激动传导异常35例（11.3%）,药物治疗加术中及早临时起博器应用,必要时置永久起搏器。结果本组2例完全性心内膜垫缺损出现室颤治疗无效死亡,余均临床治愈。结论心内直视手术术后心律失常多与心内复杂畸形并心房过度扩张、巨大室间隔缺损、术中主动脉阻断时间过长、术中心肌保护差、钾代谢失衡者等因素有关;治疗应强调合理应用抗心律失常药物和及时应用临时起搏器。     

纳洛酮在小儿心肺脑复苏中的应用

目的 探讨纳洛酮在小儿心肺脑复苏中的临床应用效果.方法 45例突发呼吸、心跳骤停患儿划分为两组,纳洛酮复苏组和常规复苏组,观察对比临床疗效.结果 纳洛酮治疗组23例中自主呼吸恢复16例(69.6%),自主循环恢复18例(78.3%),复苏成功15例(65.2%);常规复苏组分别为9例(40.9%)、14例(63.6%)和8例(36.4%),两组三项复苏指标比较差异均有统计学意义(P＜0.05).结论 纳洛酮能明显提高小儿心肺复苏的成功率,促进呼吸和循环恢复,减少致残率,在小儿心肺复苏中具有特殊的应用价值.     

纳洛酮在小儿心肺脑复苏中的应用

目的 探讨纳洛酮在小儿心肺脑复苏中的临床应用效果.方法 45例突发呼吸、心跳骤停患儿划分为两组,纳洛酮复苏组和常规复苏组,观察对比临床疗效.结果 纳洛酮治疗组23例中自主呼吸恢复16例(69.6%),自主循环恢复18例(78.3%),复苏成功15例(65.2%);常规复苏组分别为9例(40.9%)、14例(63.6%)和8例(36.4%),两组三项复苏指标比较差异均有统计学意义(P＜0.05).结论 纳洛酮能明显提高小儿心肺复苏的成功率,促进呼吸和循环恢复,减少致残率,在小儿心肺复苏中具有特殊的应用价值.     

98例呼吸心跳骤停与心肺复苏的临床分析

９８例呼吸心跳骤停与心肺复苏的临床分析福建省福州儿童医院内科（３５０００５）李淑闽，陈樊英，杨巧莉心肺复苏术（ＣＰＲ）是急救技术重要而关键的抢救措施。急救复苏水平在逐步提高，但小儿ＣＰＲ抢救成功率仍不满意。本文将１９９１～１９９５年９８例ＣＰＲ病例进...     

Central venous catheter thrombosis as a cause of SVC obstruction and cardiac tamponade in a patient with Diamond-Blackfan anemia and iron overload

Cardiac tamponade is an infrequent but potentially lethal complication related to use of central venous catheters (CVC). We present the case of a 16-year-old female with Diamond-Blackfan anemia (DBA) who developed pericardial tamponade secondary to superior venous caval obstruction caused by CVC thrombosis. The patient presented 3 months after line placement with vomiting, abdominal pain, and cardiomegaly on chest X-ray (CXR). Her condition quickly decompensated with cardiac arrest and subsequent death despite immediate pericardiocentesis. As a result of this case, our center has developed a protocol for the management of CVC problems as a means of facilitating rapid recognition of central line clots.     

Clinical significance and treatment of cardiac arrhythmia in children

Cardiac dysrhythmias during childhood are not infrequent. Often they are found in otherwise healthy children, sometimes in connection with myocarditis, cardiomyopathy, congenital heart defects or after cardiac surgery. Cardiac dysrhythmias may be subdivided in bradydysrhythmias (sinuatrial block, sinus arrest, atrioventricular block) and tachydysrhythmias (supraventricular extrasystoles, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular extrasystoles, and ventricular tachycardia). Frequently, cardiac dysrhythmias in children do not need treatment; in other cases, treatment is necessary and effective while for some cases a satisfactory treatment is not available at present.     

CARDIAC INVOLVEMENT IN JUVENILE RHEUMATOID ARTHRITIS

ABSTRACT. Cardiac involvement was diagnosed in 15 of 320 cases of JRA (4.7%) and was most frequent in children with active systemic disease. Ten children had pericarditis, 2 had myocarditis, 2 had peri-myocarditis and 1 had aortic valvulitis. The highest risk of heart involvement was found during the first three years but it could occur at any time. Recurrent episodes were seen in 60% of cases. The prognosis in pericarditis seems to be good since no patient developed cardiac tamponade or constrictive pericarditis and cardiac function evaluated by echocardiography was normal in all patients at follow-up. In patients with myocarditis and peri-myocarditis, a dilated left ventricle was found in 2 of 4 patients and 1 patient who died, had severe cardiac changes at autopsy. The prognosis in myocarditis thus seems to be worse. In valvulitis the prognosis depends on which valve is involved. The benefit of early treatment with corticosteroids is discussed.     

Cardiac involvement in juvenile rheumatoid arthritis. A follow-up study

Cardiac involvement was diagnosed in 15 of 320 cases of JRA (4.7%) and was most frequent in children with active systemic disease. Ten children had pericarditis, 2 had myocarditis, 2 had peri-myocarditis and 1 had aortic valvulitis. The highest risk of heart involvement was found during the first three years but it could occur at any time. Recurrent episodes were seen in 60% of cases. The prognosis in pericarditis seems to be good since no patient developed cardiac tamponade or constrictive pericarditis and cardiac function evaluated by echocardiography was normal in all patients at follow-up. In patients with myocarditis and peri-myocarditis, a dilated left ventricle was found in 2 of 4 patients and 1 patient who died, had severe cardiac changes at autopsy. The prognosis in myocarditis thus seems to be worse. In valvulitis the prognosis depends on which valve is involved. The benefit of early treatment with corticosteroids is discussed.     

Pediatric pericardial tamponade presenting as altered mental status

The purpose of this case report is to illustrate the diagnostic difficulties of pericardial tamponade and to suggest that focused cardiac ultrasound be included in the resuscitative care of pediatric shock. Three cases of cardiac tamponade are presented. Each patient had a syncopal episode and presented with altered mental status and hypotension. Muffled heart tones, distended neck veins, and electrocardiogram and chest radiograph abnormalities were not present. Hypotension was not responsive to intravenous volume expansion treatment. Diagnostic delays would have been prevented if focused cardiac ultrasound had been included in the resuscitative care of shock.     

Cardiac tamponade secondary to umbilical venous catheterization accident in a premature infant]

BACKGROUND. Cardiac tamponade is a rare and sometimes severe complication of umbilical venous catheterization. CASE REPORT. A premature newborn (gestational age: 30 weeks, birth weight: 1,215 g) required assisted ventilation and umbilical venous catheterization for respiratory distress. Subsequent chest X-ray showed the ascending tip of the catheter lying in the left atrium, inside the auricle. At the age of 16 hours, the infant presented with episodes of bradycardia. Despite a second endotracheal intubation, a sudden vascular collapse necessitated cardiac massage plus sodium bicarbonate and epinephrine. An ultrasound examination was performed because of the persistence of the vascular collapse; it showed a clear echo-free space between the epicardium and pericardium, suggesting pericardial effusion. The patient responded dramatically to pericardial aspiration, providing hemorrhagic fluid containing 20 g per liter glucose. DISCUSSION. Cardiac tamponade probably occurred in this patient as a result of perforation of the atrial wall. Ultrasonography showed no local thrombus, but confirmed the cardiac compression by pericardial fluid and the localization of the tip of catheter in contact with the atrial wall. This case led us to review the mechanical complications of umbilical venous and/or percutaneous catheterization and the rules for their use. CONCLUSION. This complication must be suspected in all patients having a central venous catheter that present with vascular collapse.     

先天性心脏病合并气道异常的临床分析

目的 探讨先天性心脏病（CHD）合并气道异常患儿的临床特征和预后。方法 回顾性分析重庆医科大学附属儿童医院2012年1~12月行胸部多排螺旋CT（MDCT）+气道重建和（或）纤维支气管镜（纤支镜）检查的住院CHD患儿的临床资料,按是否合并气道异常分为气道异常组和气道正常组,根据检查指征的不同,将气道异常组进一步分为心脏指征亚组和气道指征亚组。从病史中截取临床特征、CHD类型、气道异常类型、治疗和预后等资料,行气道正常组和异常组的比较。 结果 460例CHD病例进入分析。气道异常组195例（42.4%）,男113例,中位年龄6月龄（1 d至14.5岁）;气道正常组265例,男157例,中位年龄3.9月龄（1 d至15.4岁）。①166/195例存在1种气道异常,包括：单纯气道狭窄（125例,64.1%）、单纯气管性支气管（21例,7.2%）、单纯对称性支气管（8例,4.1%）和单纯气道软化（6例,3.1%）等,29例伴2种及以上气道异常;外源性压迫所致气道狭窄占80.9%（123/152）。②不同类型CHD合并气道异常的比例：血管环为84.2%,梗阻型为51.5%,发绀型为49.1%,左向右分流型为33.8%。气道指征亚组左向右分流型的比例高于心脏指征亚组（62.4% vs 20.3%）,发绀型比例低于心脏指征亚组（12.0% vs 51.4%）。③气道异常组喘息、既往肺炎≥3次的比例显著高于气道正常组（P＜0.05）。 ④气道异常组均未行外科治疗,随访复查MDCT+气道重建19例（轻度气道狭窄4例,中度气道狭窄15例）,其中气道狭窄消失6例（CHD术后均>1年）,减轻6例（CHD术后 <1年5例）,无明显变化5例（出院>1 年,CHD均未矫治）,加重者2例。气道异常组死亡22例。结论 儿童CHD合并气道异常的类型以气道狭窄最多见。对血管环和（或）反复呼吸道感染、喘息的CHD患儿应注意合并气道异常可能。大多数继发性轻中度气道狭窄在外源性压迫解除后1年以上,气道狭窄可能逐渐恢复正常。     

Neonatal cardiac tamponade and pleural effusion resolved with chest tube placement

Pericardial effusion and cardiac tamponade secondary to umbilical venous catheterization are rare complications but potentially fatal. This article reports a case of cardiac tamponade and right pleural effusion secondary to transudation of hyperosmolar fluid from an appropriately placed umbilical venous catheter. The infant survived as a result of early diagnosis by echocardiography and urgent chest tube placement that drained both pleural and pericardial effusions. Cardiac tamponade should be highly suspected in any neonate with a central venous catheter who develops sudden, unexplained clinical deterioration in cardiopulmonary status even when the line is properly placed, and urgent echocardiography or pericardiocentesis should be considered early in management of such patients. Umbilical venous catheterization should be considered only for a select group of sick neonates due to risks involved with these lines. When an umbilical venous catheter is placed, special precautions should be taken and maintenance guidelines followed.     

儿童多发性大动脉炎合并心功能不全5例病例系列报告

目的 总结儿童多发性大动脉炎（TA）合并心功能不全的临床特征。方法 回顾性分析首都儿科研究所附属儿童医院2013年1月至2019年12月确诊的TA合并心功能不全患儿的临床资料。结果 共5例患儿进入本文分析,均为女性,起病年龄2~14岁。以心脏症状起病4例,包括胸闷、心悸、头晕、乏力、多汗。血管杂音5例,脉弱/无脉4例,高血压4例。5例均合并心脏瓣膜受累,3例为多瓣膜受累。二尖瓣关闭不全4例;主动脉瓣关闭不全3例,其中2例伴有升主动脉扩张;三尖瓣关闭不全3例;冠状动脉扩张3例。5例临床分型均为Ⅲ型（混合型）。4例接受糖皮质激素和（或）免疫抑制剂治疗,2例接受TNF-α拮抗剂英夫利昔单抗治疗。1例失访,4例随访6~48个月,患儿症状均有不同程度好转,除已有不可逆心脏损伤外,炎性指标均正常,无新发病灶。1例合并顽固高血压,拟接受外科手术治疗。结论 TA患儿应定期行心脏超声检查以及早发现心脏病变,、及时干预。以心脏症状起病的患儿,除应考虑原发性心脏疾病,还应警惕TA累及心脏的可能。TA合并心功能不全患儿中,主动脉和肾动脉出现血管狭窄者,多合并高血压。     

Cardiac tamponade as a complication of ventriculo atrial shunt

Cardiac tamponade is an uncommon disorder in pediatric patients. We report a case of cardiac tamponade secondary to accumulation of cerebrospinal fluid due to ventriculo-atrial derivation (VAD) disfunction. An 11-month-old girl was assisted because of respiratory distress and tachycardia, without fever. She had a ventriculoatrial derivation, because of hydro-cephalus since two month earlier. The echocardiogram showed a pericardial effusion and the distal VAD located inside the right cardiac ventricle. The distal VAD was retired and replaced between superior cava vein and right atrium. The patient recovered ad integrum without pericardial effusion. In cases of patients with VAD presenting a clinical disorder, it should be ruled out VAD dysfunction or inappropriate placement.