Differing lung function development in infants with univentricular hearts compared with healthy infants

Aim: To compare the difference in lung function development of healthy controls and patients with univentricular hearts from birth prior to surgery and during the first year of life when cardiac shunt procedures and the cavopulmonary connection are required. Methods: Tidal flow‐volume measurements and single‐occlusion tests were performed from birth serially up to 18 months of age on 28 unsedated spontaneously breathing infants with univentricular hearts and 58 healthy control infants. Results: Infants with univentricular heart physiology had low tidal volumes, low compliance of the respiratory system and high respiratory rate at birth, which over time normalized, whereas the peak expiratory flow increased during the study period. The lung function measured at birth was predictive of later lung function measurements. Conclusion: The pattern of lung function development is different in the patients with univentricular hearts compared to healthy controls. Lung function measured at birth is predictive of later lung function.     

极低出生体重儿支气管肺发育不良潮气呼吸肺功能临床观察

目的 研究极低出生体重儿支气管肺发育不良(bronchopulmonary dysplasi,BPD)潮气呼吸肺功能的改变.方法 选取在温州市儿童医院住院的262例极低出生体重儿作为研究对象,在出院前1周内和纠正胎龄6~8个月时做潮气呼吸肺功能检测.根据临床诊断,分为BPD组(65例)和非BPD组(197例),BPD组根据严重程度分为轻度BPD组(31例)、中度BPD组(20例)和重度BPD组(14例),比较不同组患儿的肺功能指标.结果 出院前1周内测量潮气呼吸肺功能显示,BPD组患儿呼吸频率较非BPD组均增快(P均＜0.05);呼气峰流速,75%、50%、25%潮气量时的呼气流速比较,均为重度BPD组高于其余组(P均＜0.05),轻度BPD组低于非BPD组(P均＜0.05);达峰时间比、达峰容积比BPD组较非BPD组均降低,BPD程度越严重,下降越明显(P均＜0.05);各组间潮气量比较差异无统计学意义(P＞0.05).矫正胎龄6~8个月时行潮气呼吸肺功能检查,呼气峰流速,75%、50%、25%潮气量时的呼气流速比较,提示重度BPD组仍较其余组均高(P均＜0.05),达峰时间比、达峰容积比仍低于其余组(P均＜0.05),而其余各组间比较各指标差异均无统计学意义(P＞0.05).结论 出院前1周内BPD患儿有不同程度的肺功能损伤,但随日龄增大(矫正胎龄6~8个月时),部分肺功能指标逐渐改善,但早期重度小气道阻塞性病变仍较严重,因此,积极预防、治疗BPD对呼吸道疾病的防治有重要意义.     

婴幼儿潮气呼吸肺功能临床应用进展

潮气呼吸肺功能检测经由流量传感器获得潮气流量、容积信号,可用于评价潮气呼吸状态肺功能,虽然受部分因素干扰,但因其具有高敏感性、高安全性、无需儿童主动配合且易操作等明显优势,所以临床广泛应用于婴幼儿,包括婴幼儿喘息、新生儿支气管肺发育不良等疾病的临床诊断与鉴别诊断、预后评价等方面。该文对国内外潮气呼吸肺功能在婴幼儿中的应...     

呼吸窘迫综合征新生儿治疗后潮气呼吸肺功能检测

目的探讨不同胎龄以及不同程度的呼吸窘迫综合征(RDS)新生儿经治疗后肺功能的情况。方法 107例RDS新生儿分为小于34周早产儿组(65例),晚期早产儿组(21例)及足月儿组(21例),同时选取121例非RDS患儿作为对照组。根据RDS程度将RDS新生儿分为轻度RDS(1、2级)及重度RDS(3、4级)。于纠正胎龄44周时行潮气呼吸肺功能测定。结果不同胎龄RDS新生儿的肺功能参数未见明显差异;RDS组的达峰时间比(TPEF/t E)、达峰容积比(VPEF/VE)较同胎龄对照组小(P0.05);两组不同程度RDS新生儿于纠正胎龄44周时TPEF/t E、VPEF/VE也低于对照组(P0.05),且随着RDS程度加重,其值呈下降趋势。结论 RDS新生儿纠正胎龄44周时肺功能水平明显低于非RDS新生儿;RDS新生儿纠正胎龄44周时潮气呼吸肺功能水平与胎龄无关,主要与RDS严重程度有关。     

婴幼儿呼吸道合胞病毒肺炎和肺炎支原体肺炎患儿肺功能的研究及临床意义

目的探讨呼吸道合胞病毒(RSV)、肺炎支原体(MP)以及混合感染所致婴幼儿肺炎患儿的肺功能变化及其临床意义。方法选取于2005-10—2006-04因支气管肺炎于苏州大学儿童医院治疗的婴幼儿151例,运用直接免疫荧光法(DFA)和定量酶联免疫吸附试验(ELISA)分别检测肺炎患儿痰液中呼吸道合胞病毒和血清中肺炎支原体特异性抗体。采用瑞士ECOMEDICS公司的V’max26(EXHALYZER)肺功能仪对151例婴幼儿(根据年龄和病原不同分组)进行肺功能检测,观测患儿潮气呼吸流速容量环形态及其各项指标变化。结果呼吸道合胞病毒肺炎、肺炎支原体肺炎或两者混合感染患儿潮气流速容量环均变窄,呼气曲线升枝陡峭,呼气高峰提前,降枝呈波谷样凹陷。呼气峰流速因年龄不同而有所差异,1岁以内组肺炎患儿呼气峰流速增高(P<0.05),而～3岁组肺炎患儿呼气峰流速略降低(MP感染组P<0.05)。RSV、MP急性感染均表现为呼吸频率(RR)、潮气呼气峰流速/呼气量(PF/Ve)、潮气呼气峰流速/呼气达峰时间(PTEF/TPTEF)增加,每公斤潮气量(VT/kg)、呼气达峰时间比(TPTEF/TE)、呼出75%潮气量时呼气流速(TEF25%)、到达潮气呼气峰流速时呼气量(VPTEF),以及代表小气道功能的指标25/PF、%V-PF下降,与健康对照组比较差异均有显著性。反映大气道功能的指标潮气呼气中期流速/潮气吸气中期流速(ME/MI)差异无显著性。不同病原组间肺功能各指标差异无显著性。潮式呼吸参数用两样本均数t检验和多样本均数的方差分析。结论RSV和MP感染所引起的肺炎均能导致婴幼儿肺功能的损害,主要表现为小气道阻塞性改变。RSV和MP急性期感染之间肺功能损害程度并无显著区别,预后有无差别还有待于进一步的随访研究。TBFV环可作为评价临床上婴幼儿肺功能的损害程度的客观依据。     

潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的应用

目的 探讨潮气呼吸分析参数结合胸部CT在评价先天性心脏病患儿肺功能中的临床应用价值.方法 对44例先天性心脏病儿童进行潮气呼吸肺功能测定,并对其中28例进行胸部螺旋CT三维重建气管、支气管树成像(CTB).同时选取普通肺炎患儿64例进行潮气呼吸肺功能测定作为对照,并对其中49例进行胸部CT检查.结果 44例先天性心脏病患儿呼吸频率(RR)增快,吸气时间(TI)缩短,达峰时间比(TPTEF/TE)、到达潮气呼气峰流速时的呼气量(VPTEF)、达峰容积比(VPEF/VE)明显下降(P<0.01),呼气峰流速(PTEF)和75%潮气量时的潮气呼气流速(TEF 75)升高(P<0.05).28例先天性心脏病患儿胸部CT显示肺部感染、气道狭窄、肺气肿和肺不张,患病率明显高于对照组(P<0.05).结论 潮气呼吸参数中TPTEF/TE、VPTEF、VPTEF/VE能反映先天性心脏病阻塞性通气功能障碍,胸部CT能进一步显示通气功能障碍的原因,两种无创技术相结合,能较全面反映先天性心脏病患儿的肺功能状态.     

足月新生儿肺通气功能肺力学改变与心功能的关系

目的 探讨足月新生儿肺通气功能、肺力学及心功能的变化规律及其相关性.方法 200例足月儿,据日龄分为A、B、C、D四组,其日龄分别为0～24 h、～72 h、～1周、～28 d.采用德国耶格公司Master screen Paed型肺功能仪测定肺通气功能及单次阻断法测定气道阻力、肺顺应性.肺功能主要参数:潮气量(TV)、分钟通气量(MV)、呼吸系统顺应性(Crs)、呼吸系统阻力(Rrs).采用美国SonoSite 180 PLUS彩色多普勒超声诊断仪检测心功能.心功能主要参数:每搏输出量、心输出量(CO).结果 A、B、C、D四组的TV分别为20.2±3.8、21.1±3.7、22.3±4.5、23.9±4.9(ml),C、D组TV与A组比较,D组TV与B组比较,差异有显著性(P＜0.05).Rrs、Crs组间差异无显著性(P＞0.05).A、B、C、D四组CO分别为0.93±0.23、0.93±0.23、1.02±0.21、1.08±0.27(L/min),D组CO与A、B组比较差异有显著性(P＜0.05).CO与Rrs呈负相关(r=-0.16,P＜0.05),与MV、TV、Crs呈正相关(r分别为0.50、0.54、0.13,P均＜0.05).结论 足月儿生后72 h后肺通气功能趋于稳定.左心输出量于生后1周明显增加.肺通气功能和肺力学指标是影响心功能的因素.

Abstract：

Objective To investigate the dynamic change and correlation of the pulmonary ventilative function, mechanic and cardiac function in the term infants. Methods Twenty hundred term infants were divided into A 、B 、C and D groups by age which was 0 ～ 24 h, ～ 72 h, ～ 1 w and 28 d respectively. The lung ventilative and mechanical function were measured respectively by using techniques of tidal breathing flow-volume loop(TBFVL)and the single occlusion. The Master screen Paed-lung function devices of Germanic JAEGER Co. was be used in this study. The parameter of pulmonary function including minute volume(MV) ,tidal volume (TV), respiratory system compliance(Crs) and respiratory system resistance (Rrs). The cardiac function were measured by using SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus. The main parameter of cardiac function including cardiac output(CO) and stroke volume(SV). Results The TV of A, B ,C and D group were 20. 2 ± 3.78,21. 1 ± 3.71,22. 3 ± 4. 48 and 23. 9 ±4.90 (ml)respectively, the TV of C and D group were higher than that of A group, and the TV of D group was higher than that of B group (P ＜ 0. 05).There were no significantly difference of Crs, Rrs among A, B, C and D group(P ＞ 0. 05). The CO of A,B,C and D group were 0.93 ±0. 23,0.93 ±0.23,1.02 ±0.21 and 1.08 ±0.27 (L/min) ,the CO of D group was higher than that of A and B groups (P ＜ 0. 05). The CO was negative correlation with Rrs (r = - 0. 16,P ＜ 0. 05) and positive correlation with MV、 TV、 Crs (r was 0. 50、 0. 54、0. 13 respectively, P ＜ 0. 05).Conclusion The lung ventilative function is mature gradually with increasing age. The cardiac output has been obviously improved for postnatal 1 week in the term infants. The pulmonary ventilative function and mechanic parameter are important effective factors of cardiac function.     

母亲妊娠期糖尿病对新生儿左心功能的影响

目的：评估妊娠期糖尿病（GDM）母亲的新生儿左心功能状况。方法：GDM母亲娩出的新生儿40例（GDM组）及正常新生儿40例（对照组）作为研究对象,应用超声二维斑点追踪成像技术检测室间隔厚度、左室后壁厚度、射血分数,并计算左室旋转和扭转参数。结果：GDM组新生儿室间隔舒张厚度（0.45±0.06 mm）较对照组（0.34±0.05 mm）增大;GDM组左室后壁舒张厚度（0.45±0.17 mm）亦较对照组（0.31±0.02 mm）增大,差异均有统计学意义（P0.05）。GDM组新生儿内膜旋转峰值、外膜旋转峰值、平面旋转峰值、跨壁扭转峰值均较对照组升高,差异有统计学意义（P<0.05）。结论：GDM母亲的新生儿左心室的形态和旋转及扭转运动发生变化,心功能虽受到损害,但处于代偿状态,能维持正常的射血功能。超声二维斑点追踪成像技术可作为早期检测新生儿左心功能的良好手段。     

气管支气管软化患儿潮气呼吸肺功能特征的研究

目的探讨气管支气管软化(TBM)患儿潮气呼吸肺功能的特征,为TBM患儿的诊断、疗效评估、预后判断提供新的思路。方法选取30例经电子支气管镜诊断为TBM的患儿作为研究组,30例健康儿童作为正常对照组。正常对照组和TBM组初诊时以及确诊后3个月、6个月、9个月、12个月进行潮气呼吸肺功能测定。结果 TBM确诊时与对照组在潮气量及吸气时间、呼气时间、吸呼比的差异无统计学意义(P0.05);与对照组比,TBM组确诊时的呼吸频率较快,达峰时间比和达峰容积比较低,差异具有统计学意义(P0.01);TBM患儿初诊时及确诊后3、6、9、12个月的潮气呼吸肺功能达峰时间比、达峰容积比逐渐增大。结论 TBM患儿潮气呼吸肺功能具有特征性改变,而且随着年龄增大,潮气呼吸肺功能逐渐接近正常。     

Urodilatin excretion and its correlation with sodium excretion in healthy full-term newborn infants

BACKGROUND: Urodilatin (URO) is a member of the natriuretic family, cleaved by the kidney, which acts as a paracrine hormone in the regulation of natriuresis and diuresis. In newborn infants the excretion of urodilatin and its biological effects have not been explored. METHODS: We measured urinary URO excretion, by direct RIA (radioimmunoassay), as well as its correlation to neonatal body weight loss, and sodium homeostasis in 30 full-term newborn infants on the 4th day of life. RESULTS: The URO excretion, estimated as URO:creatinine ratio, was significantly correlated to sodium excretion. CONCLUSION: These data show that in full-term newborn infants the mechanisms that control synthesis, excretion and signal transduction of URO are developed and that URO contributes to natriuresis regulation.     

剖宫产儿早期潮气呼吸肺功能的研究

目的：研究剖宫产儿早期潮气呼吸肺功能各项指标的特点。探讨剖宫产对新生儿早期肺功能的影响。方法：研究对象分两组:剖宫产组42例,阴道分娩组33例;采用潮气呼吸法测定两组新生儿1h内潮气呼吸肺功能的各项指标。主要参数:每分通气量(MV),呼吸频率(RR),潮气量(VT/kg),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间(TPEF),达峰时间比(TPEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%,50%,75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%)。同时描绘出流速容量环(TFVcurve)。结果：剖宫产组MV为1.16±0.31L/min,VT/kg4.81±1.05mL/kg较阴道分娩组1.34±0.33L/min,5.55±1.24mL/kg明显缩小(P<0.05)。PTEF为69.40±21.96mL/s,TEF25%为62.17±20.62mL/s较阴道分娩儿59.03±15.23mL/s,51.52±13.83mL/s明显增快(P<0.05)。反映气道阻塞的指标:TPEF/TE和VPEF/VE分别为(66.08±11.51)%和(62.19±8.69)%高于经阴道分娩组(60.36±9.70)%和(55.75±7.28)%(P<0.05)。而RR,TI,TE,TI/TE,TEF50%,TEF75%两组无显著差异(P>0.05)。流速容量环:两组新生儿流速容量环呈较狭长的不规则椭圆型,呼气流速峰值延迟出现,剖宫产组的流速容量环窄于经阴道分娩儿,呼气流速峰值高于阴道分娩组。结论：剖宫产儿1h内潮气呼吸肺功能显示潮气量、每分通气量小于经阴道分娩儿,剖宫产儿较阴道分娩儿在1h内限制性通气功能障碍更明显,大气道的阻塞亦更明显。     

更昔洛韦治疗先天性巨细胞病毒感染患儿的系统评价

目的：评价更昔洛韦（GCV）治疗先天性巨细胞病毒（CMV）感染的疗效及安全性。 方法：计算机检索PubMed（1988.1～2009.1）、EMbase（1988.1～2009.1）、Cochrane图书馆（2003年第3期和2009年第1期）、中国学术期刊全文数据库（1994.1～2009.1）、中国生物医学文献数据库（1994.1～2009.1）、中文生物医学期刊文献数据库（1994.1～2009.1）,纳入用GCV治疗及未用GCV治疗先天性CMV感染的随机及半随机对照试验。对研究人群的干预措施及结果：进行分析评价及meta分析。结果共纳入10篇文献。meta分析结果表明,GCV治疗后在先天性CMV感染患儿的病情好转率（91.4%vs 34.0%,P＜0.01）及病毒感染指标转阴率（87.6%vs 15.3%,P＜0.01）这两方面均明显高于未治疗的对照组。GCV治疗后还可明显降低CMV感染患者的听力障碍发生率（4.7% vs 37.2%,P＜0.01）。GCV治疗组的不良反应发生率低。结论：本系统评价提示,对先天性CMV感染的婴儿,使用GCV治疗可以增加患儿的治疗好转率,增加CMV感染指标的转阴率,减少听力障碍的发生率,而GCV的不良反应发生率低。但因纳入研究的总样本量较小,证据强度有限,需更多高质量研究证实。［中国当代儿科杂志,2010,12（1）：35-39］     

Preoperative cranial ultrasound findings in infants with major congenital heart disease

BACKGROUND: Advances in diagnostic testing and surgical techniques have resulted in reduced mortality in neonates with congenital heart disease (CHD) and a major concern for neurological morbidity in the presence of preoperative neurological injury. OBJECTIVES: To determine the incidence and nature of preoperative cerebral ultrasound abnormalities in neonates with major CHD and to examine the relationship between cerebral abnormalities and the type of CHD. METHODS: Retrospective study; inclusion criteria: (1) neonates with major CHD admitted to the NICU over a 3-y period, (2) gestational age >35 wk, (3) documented preoperative cranial ultrasound available; exclusion criteria: (1) small for gestational age, (2) other congenital anomalies and/or chromosomal abnormalities, (3) a 5-min Apgar score <7, (4) congenital infection. Cranial ultrasounds (CUS) were reviewed without knowledge of the cardiac defect. CHDs were categorized. RESULTS: Fifty of 108 neonates with CHD met the inclusion criteria. Twenty-one patients (42%) had abnormalities on CUS. Thirteen of these (26%) had widened ventricular and/or subarachnoid spaces, three (6%) lenticulostriate vasculopathy, one (2%) calcification in the basal nuclei, and four (8%) had acute ischaemic changes. Cerebral abnormalities occurred more frequently in patients with coarctation or hypoplastic left heart syndrome (HLHS) than transposition of the great arteries (TGA) (63% vs 14%; n.s.).CONCLUSION: There is a high incidence of preoperative cerebral ultrasound abnormalities in this group of neonates with major CHD.     

Amplitude integrated electroencephalographic activity in infants with congenital heart disease before surgery

Background

Infants with congenital heart disease (CHD) are at risk for brain injury. An accurate tool to monitor brain function is amplitude integrated EEG (aEEG). It records both background patterns and electrographic seizure activity (EA).

Aims

Our aim was to determine aEEG patterns in infants with CHD and to determine the differences between infants with a cyanotic or an acyanotic CHD.

Study design and subjects

Sixty-two full term newborns had either a cyanotic CHD (transposition of the great arteries (n = 24)) or an acyanotic CHD (hypoplastic left heart syndrome (n = 26), critical aortic valve stenosis (n = 1) or aortic coarctation (n = 11)). The background patterns, sleep-wake cycling (SWC), and EA were assessed. The first 72 h after starting prostaglandin E₁-therapy were used for analysis.

Results

The background patterns were mildly abnormal in 45% of the infants and severely abnormal at some point during the recording in 14% of the infants. We found no differences in background patterns between the two groups. EA was present in 12 (19%) infants. EA was more frequent in infants with acyanotic CHD (OR 9.4, 95% CI 1.1-78, p = 0.039). SWC was equally frequent in infants with cyanotic and infants with acyanotic CHD. A severely abnormal aEEG and EA were associated with more profound acidosis.

Conclusions

Before surgery the majority of infants with a CHD had an abnormal aEEG. aEEG helped to identify EA and it was a useful tool to evaluate brain function prior to surgery in CHD.     

毛细支气管炎患婴肺功能检测及评价

目的观察婴儿毛细支气管炎(毛支)的肺功能动态变化情况以及呼吸道合胞病毒(RSV)感染对其的影响并探讨其临床意义。方法对42例毛支婴儿(其中RSV感染22例)急性期、恢复期及16例正常组婴儿进行肺功能检查。结果毛支急性期呼吸频率(RR)增高、每千克体重潮气量(Vt/kg)、达峰时间比(tPTEF/tE)及达峰容积时间比(vPTEF/vE)均下降,与正常组比较差异有统计学意义;其中RR、tPTEF/tE及vPTEF/vE与恢复期比较差异有统计学意义。而恢复期与正常组比较各项指标差异均无统计学意义。在急性期RSV感染毛支患儿tPTEF/tE、vPTEF/vE下降更明显,与非RSV感染患儿比较差异有统计学意义;在恢复期RSV感染患儿与非RSV感染患儿比较,各项指标差异均无统计学意义。结论毛支急性期,肺功能呈现小气道阻力增高、阻塞性通气障碍改变,恢复期小气道功能好转,说明小气道功能异常能在较短时间内恢复。同时在急性期RSV感染比非RSV感染引起更强的下呼吸道阻塞的肺功能表现。婴儿肺功能检查是判断病情、评估疗效、推断预后的实用和可靠的方法。     

婴儿先天性心脏病93例回顾性分析

目的 探讨婴儿先天性心脏病(CHD)的临床特点,提高早期诊断率.方法 研究对象为2006年1月至2007年6月安徽省蚌埠医学院第一附属医院儿科经彩色多普勒超声心动图(CFM)诊断为CHD的住院婴儿93例,按是否是新生儿分为2组:Ⅰ组:1h至28d(n=14),Ⅱ组:28d至1岁(n=79),对其临床资料进行回顾性分析.结果Ⅰ组CHD以复合畸形为主,共7例(7.5%),以房间隔缺损(ASD)合并室间隔缺损(VSD)最多见(2.2%).Ⅱ组CHD以单纯畸形为主,共66例(71.0%),最常见的CHD类型为VSD(46.2%).两组CHD类型构成比比较有统计学意义(P＜0.05).8例合并心脏外畸形(8.6%).临床表现多样,在Ⅰ组尤其不典型,以呼吸急促、青紫、心脏杂音多见,易反复患肺炎,并发心力衰竭.结论婴儿CHD类型较多,临床表现复杂,对可疑的CHD婴儿应及时行超声心动图检查,早期诊断并制定恰当的治疗方案.     

人博卡病毒肺炎和支原体肺炎患儿肺功能变化比较

目的探讨婴幼儿罹患人博卡病毒(HBoV)、肺炎支原体(MP)肺炎后的肺功能变化及其临床意义。方法选取2013年1月至2013年10月期间因支气管肺炎住院治疗的3岁的婴幼儿140例,其中HBoV阳性64例、MP阳性76例;另选正常同年龄婴幼儿38例,采用德国耶格MasterScope肺功能仪进行肺功能检测,分析比较其检测指标及潮气呼吸流速容量环形态。结果 HBoV及MP支气管肺炎婴幼儿的到达峰流速时间/呼气时间(TPTEF/TE)、到达峰流速时呼出气量/呼气容积(VPTEF/VE)、剩余25%潮气量时呼气流速(TEF25%)和剩余25%潮气量时的呼气流速/呼气峰速(25/PF)都明显低于正常同年龄对照组,差异有统计学意义(P均0.05);HBoV、MP支气管肺炎婴幼儿之间上述指标的差异则无统计学意义(P均0.05)。支气管肺炎与正常对照婴幼儿的潮气呼吸流速容量环(TBFVL)形态均有改变,都表现为呼气相高峰提前,呼气相降支呈波谷样凹陷,其中支气管肺炎婴幼儿峰度稍有降低。结论 HBoV和MP感染所引起的支气管肺炎可致婴幼儿肺功能损害,且都表现为小气道阻塞性通气功能障碍;在直观的TBFVL表现为呼气高峰左移,降支波谷样凹陷。     

婴儿先天性心脏病体外循环术后的治疗

目的 探讨婴儿先天性心脏病体外循环术后的治疗及转归.方法 对我院2005年1月至2010年11月经体外循环治疗的217例婴儿的临床资料进行回顾性分析.结果 全组术后死亡11例,住院病死率为5.1%(11/217).其中因重症低心排出量综合征死亡4例,肺动脉高压危象死亡2例,低心排出量综合征合并急性肾功能不全死亡2例,重症感染死亡1例,严重低氧血症死亡1例,慢性心包填塞导致心跳骤停死亡1例.术后住院时间7～52 d,平均14 d.结论 随着外科治疗技术的提高,婴儿体外循环下心脏手术治疗可以取得良好的治疗效果.体外循环术后采取积极有效的治疗是降低围手术期病死率的关键.

Abstract：

Objective To study the treatment and outcome in infants with congenital heart disease after cardiopulmonary bypass. Methods The clinical data of 217 infants with congenital heart disease after cardiopulmonary bypass in Shengjing Hospital from Jan 2005 to Nov 2010 were retrospectively reviewed. Results Eleven infants died and the mortality was 5. 1% ( 11/217 ). Four infants died of severe low cardiac output syndrome,2 died of pulmonary hypertension crisis,2 died of low cardiac output syndrome complicated with acute renal insufficiency, 1 died of severe infection, 1 died of severe hypoxemia,and 1 died of chronic pericardial tamponade. The postoperation length of hospital stay was 7 ～ 52 d, 14 d in average. Conclusion With the improvement of surgical techniques,cardiac surgery with cardiopulmonary bypass on infants can result in good clinical effect. Active and effective treatment can reduce the perioperative mortality after cardiopulmonary bypass.     

改良超滤在婴幼儿体外循环中的应用

目的：婴幼儿各组织器官发育尚未成熟,体外循环后各种并发症也相对较为严重。改良超滤技术被证明能减轻婴幼儿体外循环所带来的不利影响,该文分析改良超滤在幼儿体外循环手术中的应用情况。方法：分析261名1岁以下在体外循环下行心脏手术的患者,其中205例（超滤组）体外循环后行改良超滤,56例（对照组）不行改良超滤。比较两组患者的转流时间、主动脉阻断时间、术后引流量、术后输血量、术后呼吸机通气时间、术后24 h时的血球压积以及氧合指数等围手术期资料。结果：超滤组没有发生与超滤有关的并发症,两组患者转流时间和主动脉阻断时间无明显差异,超滤组患者术后引流量和输血量较对照组少,呼吸机通气时间较短,而术后血球压积以及氧合指数较对照组高。结论：改良超滤技术在幼儿体外循环心脏手术后可以明显减少出血量和输血量,可以提高肺的氧合功能,改善呼吸功能,缩短呼吸机支持时间,有利于患者术后恢复。