先天性心脏病伴重度肺动脉高压的外科治疗

目的 :总结先天性心脏病 (先心病 )合并重度肺动脉高压 (肺高压 )外科治疗和围术期处理的经验。方法 :2 0 0 0 - 0 4～ 2 0 0 3- 0 4共手术治疗合并重度肺高压的先心病患者 4 8例 ,男 2 0例 ,女 2 8例 ,年龄 2～ 4 7岁 ,平均 (17.0± 10 .5 )岁。术前肺动脉和体动脉收缩压比 (Pp/Ps)均 >0 .75 ,平均 0 .98± 0 .18,动脉血氧氧饱和度 (SaO2 ) 72 %～ 94 %。结果 :手术死亡 3例 (6 .2 5 % )。主要并发症 :低心排血量 14例 ,肺高压危象 4例 ,阵发性室上性心动过速 4例 ;死亡原因 :低心排血量 2例 ,呼吸衰竭 1例。术后SaO2 90 %～ 97% ,平均 (93± 1.3) %。随访 3个月～ 3年 ,死亡 1例 ,余患者心功能 (NYHA)均较术前改善。结论 :低心排血量和肺高压危象是合并重度肺高压的先心病患者术后的主要并发症和死亡原因 ,搞好围术期的处理是提高生存率的关键     

高海拔地区小儿先心病合并肺动脉高压的围术期护理

目的：探讨高海拔地区小儿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56例先天性心脏病合并肺动脉高压患儿手术后护理要点。结果：54例患儿均顺利撤离呼吸机,痊愈出院。2例患儿术后出现肺动脉高压危象,经处理后1例患儿好转出院,1例抢救无效死亡,无护理并发症发生。鳍论：高海拔地区先天性心脏病合并肺动脉高压患者围术期护理,术前要注重吸氧及肺动脉压力的降低;术后要特别加强呼吸道的护理、呼吸机的管理、心功能的维护,才能有效降低肺部并发症,提高手术成功率。     

40例婴幼儿室间隔缺损合并重度肺动脉高压的术后护理

先天性心脏病室间隔缺损合并中重度肺动脉高压患儿病情严重,这些患儿不论手术还是护理有它不同于儿童和成人心脏病的特殊性[1],许多因素都可以导致病情恶化,而且手术治疗并发症多,如肺动脉高压危象、肺部感染、低心排、心律失常、心衰等,这也是导致患儿死亡的主要原因,加强术后护理是提高手术成功率的有效措施.我科2009年9月~2010年10月共收治室间隔缺损合并重度肺动脉高压患儿40例,现将其术后护理体会报告如下.     

先天性心脏病伴肺动脉高压围手术期的处理

目的 总结围手术期对先天性心脏病伴肺动脉高压的治疗经验。方法 术前给予吸氧、高压氧及前列腺素E1等治疗，术中应用抑肽肺保护液，术后给予血管活性药等治疗。结果 47例病人中，死亡2例（4.3%)为重度低心排综合征;手术后并发症2例(4.3%),1例第三度房室传导阻滞,1例二氧化碳蓄积。结论 围手术期的合理治疗可减少先天性心脏病伴肺动脉高压术后并发症的发生。     

复杂先天性心脏病合并严重肺动脉高压婴幼儿术后呼吸系统的护理

复杂先天性心脏病患儿在新生儿或婴幼儿期即处于危重状态,如果不及时给予手术治疗,绝大部分因难以救治的肺炎合并心力衰竭或严重缺氧而导致死亡[1].肺动脉高压是左向右分流先天性心脏病常见的一种严重并发症,容易在术后早期诱发肺动脉高压危象,由于患儿低龄、低体重,术后病情变化快而复杂,呼吸系统的护理尤为重要,如处理不得当、不及时将会危及患儿生命.我院2005年6月～2008年12月共收治16例复杂先天性心脏病合并肺动脉高压的患儿,现将术后呼吸系统的护理要点总结如下.     

诊断性治疗先天性心脏病伴重度肺动脉高压围手术期的护理

目的探讨先天性心脏病伴重度肺动脉高压围手术期的观察与护理。方法 32例先天性心脏病伴重度肺动脉高压患儿入院后应用肺血管扩张药物作为诊断性治疗手段,通过动态观察患儿四肢末梢血氧饱和度的变化情况,为筛选手术和评估预后提供依据。对接受手术的患儿术后加强肺高压的监护和呼吸道管理。结果 32例中,26例经治疗后判断肺血管病变尚属可逆性病变,接受了手术治疗;其中,25例治愈出院,1例因术后出现肺动脉高压危象死亡。结论联合应用肺血管扩张药物,可以为肺动脉高压患儿争取到手术治疗的机会。四肢末梢血氧饱和度是判断患儿能否手术的重要观察指标。术后监护的重点在于预防肺动脉高压危象的发生。     

尿酸水平与先天性心脏病相关性肺动脉高压相关性研究

目的探讨尿酸水平与先天性心脏病相关性肺动脉高压患者病情严重程度的相关性。方法回顾性分析自2009年1月至2016年12月海军军医大学附属长海医院收治的279例先天性心脏病相关性肺动脉高压患者的临床资料,根据患者预后,分为存活组257例和病死组22例,比较两组患者基线资料,并采用Spearman秩相关进行相关性分析。结果病死组患者肺动脉收缩压、肺动脉舒张压、肺动脉平均压、尿酸、红细胞分布宽度分别为(103.60±29.67)mmHg、(49.60±18.08)mmHg、(68.36±21.73)mmHg、(0.42±0.11)mmol/L、18.00%(13.93%,75.47%),均高于存活组的(85.21±30.28)mmHg、(37.85±18.90)mmHg、(55.01±21.42)mmHg、(0.26±0.17)mmol/L、13.80%(12.80%,21.60%),差异有统计学意义(P<0.05);尿酸水平与肺动脉收缩压、肺动脉舒张压、肺动脉平均压呈正相关(P<0.01)。结论尿酸水平与肺动脉压力呈正相关,可在一定程度上反映先天性心脏病相关性肺动脉高压患者的病情严重程度。     

高原先天性心脏病合并肺动脉高压的围术期处理

目的：积极治疗高原先天性心脏病并发肺动脉高压症,减少严重并发症及降低死亡率。方法：术前应用硝普纳使肺动脉压降低,同时给予高压氧治疗。术中行房间隔和室间隔缺损修补治疗,适当应用皮质素,加强心肌保护。术后应充分应用镇静、镇痛药物;适当延长呼吸机使用时间,使PaCO2维持在25～30mmHg左右。结果：本组137例中130例治愈出院,另7例因室性心律失常,严重低心排出量综合征、肺动脉高压导致低心排出量综合征而死亡。结论：积极的术前准备以及术中、术后处理可明显减少肺动脉高压带来严重并发症,降低死亡率。     

西宁地区20例紫绀型先天性心脏病患儿围手术期的护理措施

目的:探讨紫绀型先天性心脏病患儿围手术期的护理措施.方法:选择紫绀型先天性心脏病患儿20例,手术前做好血标本的采集,预防缺氧发作,术后做好低心排的护理、呼吸道的护理等围手术期护理措施.结果:20例患儿中,治愈19例,死亡1例.结论:紫绀型先天性心脏病患儿术前做好血标本的采集,预防缺氧发作,术后做好低心排的护理、呼吸道的护理等围手术期护理措施,可以提高围手术期护理质量,提高手术成功率.     

先天性心脏病合并中重度肺动脉高压82例

先天性心脏病合并中重度肺动脉高压,是先天性心脏病常见的严重并发症之一,手术治疗风险和难度较大,术前准备、术后管理非常重要.我院于2002-05至2009-04手术治疗先天性心脏病合并中重度肺动脉高压患者82例,临床近、中期疗效良好.     

婴幼儿先天性心脏病外科治疗248例临床分析

目的:总结婴幼儿先天性心脏病外科治疗经验。方法:对248例<36月婴幼儿先心病外科手术治疗资料就诊断、临床特点、并发症及治疗结果进行回顾性分析。结果:婴幼儿先心病以室间隔缺损和法洛四联症为最常见,常合并其他畸形;年龄<12月组死亡率明显高于年龄24~36月组(P<0.05);体重<10 kg死亡率高于体重>10 kg者相差显著(P<0.01)。死亡原因以低心排出量综合征和呼吸衰竭最常见(78.9%)。结论:重危婴幼儿先心病应早期外科手术治疗,要严格手术适应症和时机,加强围手术期处理。     

提高婴幼儿心脏手术综合疗效的临床实践

目的：探讨提高婴幼儿心脏手术综合疗效的经验与方法。方法：收集总结手术矫治先心病患儿1549例，年龄3d～36（平均27．31±1．35）月，体重2．20～14．5（平均9．39±3．10）kg。其中新生儿129例、婴儿501例、幼儿898例。对其临床病理特点及围术期处理特点进行回顾性分析。结果：死亡74例，病死率4．8％，近2年平均病死率2．05％，多为急重症患儿。死亡原因为术后低心排综合征和（或）呼吸道并发症，部分患者系手术适应症选择不当或畸形矫治欠完善。结论：重视积极的术前支持治疗，改善患儿整体状况，有效减少住院术前死亡。及时准确的术前诊断和正确的手术指征、术式决策，完善的畸形矫治和良好的体外循环心、肺、脑保护措施以及围术期监护是提高手术疗效的关键。     

高龄冠状动脉硬化性心脏病的外科治疗

目的：探讨高龄冠状动脉硬化性心脏病(冠心病)患者外科治疗的特点。方法：对35例70岁以上冠心病患者外科治疗方法的选择、术前和术中的注意事项以及术后处理的特点进行回顾性分析。结果：本组病人无手术中死亡，1例术后3d死于严重的低心排综合征，其余患者术后恢复顺利。结论：合理的手术方法、做好术前准备、完善的手术技术及正确的术后管理，高龄冠心病患者的冠脉旁路移植术与一般患者相比死亡率无明显增加，且可明显改善患者症状，减轻心绞痛，提高生活质量。     

婴幼儿先心病合并肺动脉高压围术期呼吸道管理

目的　总结与分析我院近年来 2 6例婴幼儿先心病合并肺动脉高压病人围手术期呼吸道管理情况 ,以提高外科治疗效果。方法　术前常规准备 ,同时氧疗 ,术中常规应用血管扩张剂硝普钠 ,术后保持呼吸道通畅 ,应用呼气末正压 (PEEP) ,适当延长插管时间 ,严格拔管指征 ;同时静脉应用硝普钠。结果　全组 2 6例 ,2 3例治愈出院 ,3例死亡 ,占 11.5 4% ,死亡原因为术后低心排 ,呼吸衰竭。结论　术后正确选用呼吸机 ,合理调整各种参数 ,加强呼吸道管理 ,可以获得理想的治疗效果。     

完全型房室间隔缺损的外科疗效及其危险因素分析

 目的 总结完全型房室间隔缺损的矫治手术特点,通过危险因素分析,探讨提高外科疗效的方法。方法 回顾2009-01至2018-12解放军总医院第三医学中心152例完全型房室间隔缺损矫治手术的临床特点,根据围术期(手术后至出院期间)是否发生恶性事件分为两组,A组围术期发生恶性事件共18例,B组未发生围术期恶性事件共134例。通过Logistic回归分析的方法确定影响外科疗效的危险因素。结果 152例围术期发生恶性事件18例(11.8%),包括低心输出量综合征6例,肺动脉高压危象4例,全身毛细血管渗漏综合征4例,室间隔残余分流(直径≥5 mm)者2例,二尖瓣重度反流1例,Ⅱ度Ⅱ型房室传导阻滞1例。Logistic回归分析显示年龄(OR=1.063,95%CI 1.406~1.082)、肺动脉收缩压(OR=1.038,95%CI 1.012~1.070)、术前左侧房室瓣反流程度(OR=1.296,95%CI 1.193~1.387)和主动脉阻断时间(OR=1.172,95%CI 1.008~1.352)是围术期发生恶性事件的独立危险因素(P<0.05)。结论 选择合理手术年龄、降低肺动脉压力、采用有效手术方法、保护房室瓣膜功能是提高完全型房室间隔缺损矫治手术疗效的主要措施。     

Utility of cardiac CT in infants with congenital heart disease: Diagnostic performance and impact on management

BackgroundAdvances in cardiac CT (CCT) scanner technology allow imaging without anesthesia, and with low radiation dose, making it an attractive technique in infants with congenital heart disease. However, the utility of CCT using a dual-source scanner with respect to diagnostic performance and impact on management has not been systematically studied in this population.MethodsRetrospective review of infants who underwent CCT to determine the utility of CCT with respect to the following: answering the primary diagnostic question, providing new diagnostic information, prompting a change in management, and concordance with catheterization or surgical inspection.ResultsA total of 156 infants underwent 172 scans at a median age of 64 days, (IQR 4–188) from Jan 2016–Dec 2019. The most frequent diagnostic question was related to the pulmonary arteries (43%), followed by the aortic arch (30%), pulmonary veins (26%), coronary arteries (17%), patent ductus arteriosus (10%) and others (9%). A high-pitch spiral scan was frequently used (90%). The median effective radiation dose was low (0.66 ?mSv) and general anesthesia was used infrequently (23%). CCT answered the primary diagnostic question in 168/172 (98%) and added to the diagnostic information already available by echocardiography in 161/172 (96%) scans. CCT led to a change in management following 78/172 (53%) scans and had an impact on management following 167/172 (97%) scans. On follow-up, after 107/172 (62%) scans, subjects underwent cardiac surgery, and after 55/172 (32%) scans, they had cardiac catheterization. CCT findings were concordant with catheterization and/or surgical inspection in 156/159 (98%) scans.ConclusionsIn infants with complex congenital heart disease, CCT was accurate, answered the diagnostic questions in nearly all cases, and frequently added diagnostic information that impacted management. Radiation exposure was low, and anesthesia was needed infrequently.     

先天性心脏病合并肺动脉高压分级及性质的评估

鉴别先天性心脏病合并肺动脉高压是动力型还是阻力型对治疗方案的选择和预后的评估均具重要意义。本文综述先天性心脏病合并肺动脉高压的临床分级、分期及肺动脉高压性质的判断,旨在为临床诊疗提供参考。     

Evaluation of surgical procedures for cyanotic congenital heart disease by using MR imaging

ECG-gated MR imaging has been shown to be effective for the diagnosis of congenital heart disease. In this study, we assessed its role in the postoperative evaluation of surgical procedures in patients with complex congenital heart disease. MR images of 26 patients with Rastelli (five), Fontan (three), Senning (three), Damus (one), Jatene (eight), Waterston (four), and Potts (two) procedures were evaluated retrospectively. The accuracy of MR imaging was compared with that of angiography in 20 patients. The surgical anastomoses were identified in all patients. Patency, atresia, or hypoplasia of central pulmonary arteries and postoperative complications (focal stenoses of pulmonary arteries, thrombosed conduit, peri-conduit abscess) were shown. Narrowing of the right ventricular outflow tract and focal compression of the proximal pulmonary arteries were recognized as specific complications of the Jatene procedure. MR imaging appears to be effective in the postoperative evaluation of surgical procedures used for congenital heart disease. It should be considered as an alternative to repeated catheterization and angiography for the postoperative examination of children with complex congenital heart disease.     

Exercise after surgical repair of congenital cardiac lesions

Congenital heart defects arise in approximately 1% of all live births, independent of ethnic and geographical considerations. With the development of new surgical procedures and current technologies a large number of these heart lesions can be surgically corrected in infancy. In the majority of cases patients evaluated some 10 to 20 years after surgery are asymptomatic and can lead a normal life. Despite their satisfactory clinical outcome patients may, nevertheless, show an abnormal pattern of physiological responses when submitted to dynamic exercise. This paper reviews the scientific literature concerning the exercise capabilities and the cardiorespiratory adjustments to exercise in patients surgically corrected for 4 of the most common congenital heart lesions: isolated atrial septal defect, isolated ventricular septal defects, pulmonary stenosis and tetralogy of Fallot. The maximal exercise tolerance of postoperative congenital heart defect patients may usually be related to: (a) the age of the patients at the time of surgery; (b) the severity of the lesions remaining after surgery; and (c) the age of the patients at the time of investigation. Although normal maximal exercise capabilities may be found in a good number of patients operated for either of the 4 lesions considered, this does not imply normal exercise haemodynamics. A general observation made in these 4 groups of patients is that of a subnormal exercise cardiac output which may or may not be fully compensated by an increase in peripheral oxygen extraction. The limitation in exercising cardiac output may, in turn, be attributed to either a subnormal stroke volume or a limitation in the chronotropic response to exercise or a combination of both factors. Residual pulmonary stenosis, increased pulmonary vascular resistance, increased myocardial stiffness are all factors that may contribute to the cardiac output limitation. A thorough explanation of underlying causes for the abnormal haemodynamic response to exercise, however, still remains to be provided.     

动脉导管未闭50例手术治疗疗效分析

目的总结先天性心脏病动脉导管未闭（PDA）50例手术治疗经验。方法对手术治疗先天性动脉导管未闭（PDA）50例进行回顾性总结分析。结果除1例4月龄患儿重度肺动脉高压因呼吸循环衰竭于术后第1天死亡外，其余病人均痊愈出院，随访均健在，生活质量改善，心脏杂音消失，未发现导管再通病例。结论动脉导管未闭确诊后除有禁忌症外，原则上应手术治疗，手术治疗效果良好，并发症少，病死率低。加强围术期处理是降低手术死亡率的重要措施。