先天性食管闭锁围产期死亡的危险因素分析

目的：探讨影响先天性食管闭锁患儿围产期死亡的危险因素，为提高患儿的存活率提供科学的依据。方法：１９８６年９月～１９９３年１２月对孕２８周于出生后７天的围产儿进行监测，并就收集的１９５例无天性食管闭锁病例进行死亡危险因素分析，结果：先天性食管闭锁的围产期病死率为６６．７％，其中新生儿７天内死亡所占比例（７８．５％）显著高于死胎，死产所占比例（２１．５％，Ｐ〈０．００１），死亡患儿的出生体重构成比不同     

新生儿先天性食管闭锁

本文报告经手术治疗、分型明确的新生儿先天性食管闭锁２０例，探讨其诊断、治疗及预后。指出临床上以Ⅲ型多见，肺炎是最常见的并发症，确诊时间越晚肺部并发症愈重。治愈关键在于：１．早期确诊；２．食管闭锁两端之间的距离，距离短手术吻合时张力小、成功率高；３．有无其它严重畸形并存。要求儿内科医师熟悉其临床表现及Ｘ线检查方法，早期确诊手术治疗。     

新生儿先天性心脏病危险因素分析

目的 探讨新生儿先天性心脏病(简称先心病)的类型及其可能的危险因素.方法 选择2004--2008年在本院出生的165例先心病患儿和同期出生的202例健康儿进行病例对照研究,了解先心病的类型,用单因素卡方检验和多元回归分析其可能的危险因素.结果 病例组中室间隔缺损87例,占52.7%,房间隔缺损17例,占10.3%,各类复杂先心痛共占29.7%,以完全性大血管转位最多见,其次为法洛四联症.孕早期感冒服药、糖尿病合并妊娠或妊娠期糖尿病、高龄产妇(＞35岁)、曾接触杀虫剂或类似药、母亲孕前或孕早期饮酒史、主被动吸烟史、妊娠期高血压疾病、孕早期接触室内装修物及油漆、先兆流产并服药及病毒感染均是先心病发生的相关危险因素(P<0.05).结论 应加强孕期健康教育,提高产前产后诊断水平.以早期防治先心病.     

新生儿先天性心脏病危险因素分析

目的探讨新生儿先天性心脏病(简称先心病)的类型及其可能的危险因素。方法选择2004—2008年在本院出生的165例先心病患儿和同期出生的202例健康儿进行病例对照研究,了解先心病的类型,用单因素卡方检验和多元回归分析其可能的危险因素。结果病例组中室间隔缺损87例,占52.7%,房间隔缺损17例,占10.3%,各类复杂先心病共占29.7%,以完全性大血管转位最多见,其次为法洛四联症。孕早期感冒服药、糖尿病合并妊娠或妊娠期糖尿病、高龄产妇(>35岁)、曾接触杀虫剂或类似药、母亲孕前或孕早期饮酒史、主被动吸烟史、妊娠期高血压疾病、孕早期接触室内装修物及油漆、先兆流产并服药及病毒感染均是先心病发生的相关危险因素(P<0.05)。结论应加强孕期健康教育,提高产前产后诊断水平,以早期防治先心病。     

中国新生儿先天性心脏病危险因素的Meta分析

目的探讨中国新生儿先天性心脏病(CHD)的主要危险因素,为CHD的预防提供参考依据。方法系统搜集2001~2016年研究中国新生儿CHD危险因素的病例对照研究,提取相关数据,按照NOS量表对纳入文献进行质量评价,敏感性分析采用不同模型分析同一资料,采用Egger's检验评估发表偏倚。结果共纳入17篇病例对照研究,其中病例组2 930例,对照组4 952例。Meta分析显示中国新生儿CHD主要危险因素为:孕母高龄(OR=2.649,95%CI:1.675~4.189)、感冒或发烧(OR=4.558,95%CI:2.901~7.162)、孕早期用药(OR=3.961,95%CI:2.816~5.573)、被动吸烟(OR=2.766,95%CI:1.982~3.859)、不良生育史(OR=2.992,95%CI:1.529~5.856)、接触噪声(OR=3.030,95%CI:1.476~6.217)、受到辐射(OR=2.363,95%CI:1.212~4.607)、居室新装修(OR=4.979,95%CI:3.240~7.653)、孕期糖尿病(OR=5.090,95%CI:3.132~8.274)、饲养宠物(OR=2.048,95%CI:1.385~3.029)。结论孕母高龄、感冒或发烧、孕早期用药、被动吸烟、不良生育史、接触噪声、受到辐射、居室新装修、孕期糖尿病、饲养宠物可能增加新生儿CHD的患病风险。     

先天性心脏病危险因素的Meta分析

目的 探讨小儿先天性心脏病发病的危险因素.方法 通过检索Pubmed、Medline、万方数据库、维普数据库、中国期刊全文数据库等,检索2001 ～ 2012年国内外公开发表的先天性心脏病危险因素的相关文献,并采用Stata Version 11.0(Stata Corporation;College Station,TX)软件进行统计分析.结果 共纳入40篇,中文文献23篇,英文文献17篇.各危险因素合并OR值分别为:有家族遗传史:3.37;精神刺激:2.93;孕早期感冒:2.57;父亲嗜酒:2.47;孕期接触不良化学物:2.38;噪音污染:2.36;不良生育史:2.16;孕期服药:2.07;父亲职业接触不良物质:1.65;孕期吸烟:1.58;孕妇年龄偏大:1.30;孕期饮酒:1.17.结论 家族遗传史、精神刺激、孕早期感冒、孕期接触不良化学物、噪音污染、不良生育史、孕期服药、孕期吸烟、孕妇年龄偏大和父亲嗜酒、父亲职业接触不良物质是先天性心脏病发病的危险因素.孕期饮酒尚不能认为是先天性心脏病的危险因素.     

先天性食管闭锁术式改良

我院自１９９５年采用改良术式治疗先天性食管闭锁，效果满意，介绍如下。手术方式：全麻下经右胸膜外入路开胸，找到食管闭锁的上下盲端后，将上盲端充分游离，于其下端前壁作一倒“Ｕ”字切开并将其向下翻转形成一舌形瓣。舌形瓣的宽度要根据上盲端的横径和上下盲端的间...     

先天性食管闭锁和气管食管瘘预后相关因素分析

目的 探讨影响食管闭锁预后的可能相关因素.方法 2005年1月至2007年12月手术治疗各型食管闭锁患儿共75例,将出生体质量、胎龄、入院日龄、Lewis Spitz分组、闭锁分型、术前合并肺炎、合并畸形、手术方式、吻合口瘘发生、应用静脉营养作为影响预后的相关因素进行分析.结果 Ⅲ型发病率为87%,平均出生体质量为(2.7±1.6)kg,胎龄为(38.9±1.6)周,入院日龄为3 h～22 d,病死率为8%(不包括放弃积极治疗的病例).胎龄、出生体质量、入院日龄、Lewis Spitz分组、合并肺炎、合并畸形不是影响食管闭锁预后的相关因素.进行环形肌层松解的病例预后较差,吻合口瘘的发生与手术方式并不直接相关.分型、环形肌层松解手术、术后合并吻合口瘘及静脉营养支持为预后影响相关因素.结论 吻合1:2瘘的发生与手术方式并不直接相关;单纯型(Ⅰ型)或长距离闭锁不宜选择Ⅰ期食管吻合;对于最常见的Ⅲ型闲锁,即使术后出现吻合口瘘,如果采取积极治疗也可取得良好的预后.     

先天性心脏病婴儿生长发育状况及其危险因素分析

目的 调查评估先天性心脏病婴儿生长发育状况,探讨其生长落后的发生率及其危险因素.方法 采用Z评分法对2010年8月至2011年8月期间在我科住院行心脏手术的354例先天性心脏病婴儿进行营养状况评估,根据评估结果分为营养不良组及非营养不良组,采用卡方检验及多元回归分析对造成生长发育落后的可能危险因素进行单因素及多因素回归分析.结果 354例中低体重患儿108例(30.5％),经多元回归分析,低出生体重(OR=3.844,P=0.001)、肺动脉高压(OR=5.702,P=0.000)、肺炎(OR=2.161,P=0.005)与其显著相关;生长迟缓患儿62例(17.5％),经多元回归分析,低出生体重(OR=4.137,P=0.000)、肺动脉高压(OR=2.352,P=0.047)、肺炎(OR=3.417.P=0.000)与其显著相关;消瘦患儿95例(26.8％),经多元回归分析,肺动脉高压(OR=2.747,P=0.001)与其显著相关.结论 低出生体重、肺动脉高压、肺炎对先天性心脏病婴儿生长发育可产生显著影响;是否紫绀与小婴儿营养不良无显著相关.     

新生儿先天性心脏病危险因素的病例对照研究

目的探讨新生儿先天性心脏病（简称＂先心病＂）的类型及其可能的危险因素,为制定预防措施提供参考依据。方法采用1∶1配对病例对照研究方法,选取2011年5月至2013年12月在本院新生儿科住院治疗的先心病患儿为病例组,无先心病的患儿为对照组,对两组患儿的亲生父母进行统一问卷调查。对所有研究因素进行单因素及多因素条件Logistic回归分析.筛选出与先心病发生相关的危险因素。结果研究期间本院新生儿科共收治3682例患儿,病例组和对照组各纳入139例。139例先心病患儿以室间隔缺损为主（34.5%）,其次为房间隔缺损＋室间隔缺损（14.4%）、房间隔缺损（10.8%）和室间隔缺损＋动脉导管未闭（10.1%）。母亲孕前及孕早期糖尿病（OR=7.321）、孕早期服用抗生素（OR=6.996）、孕早期被动吸烟（OR=4.948）、先心病家族史（OR=3.252）和孕早期上呼吸道感染（OR=3.461）均是先心病发生的相关危险因素（P〈0.05）。结论应加强孕期健康教育,提高产前产后诊断水平,以早期防治先心病,从而有效降低先心病的发病率。     

Study of 24 cases with congenital esophageal atresia: What are the risk factors?

BACKGROUND: Recovery from esophageal atresia (EA) and tracheoesophageal fistula (TEF) has improved markedly over the years. But postoperative complications, however, have remained. This study evaluates recovery, preoperative, and postoperative status of patients with EA/TEF. METHODS: A retrospective study review was undertaken in 24 patients with EA/TEF after primary anastomosis (January 1975 through September 2003). RESULTS: There were no patients who had major cardiac anomalies or trisomy 18. In total, 17 of 24 (70.8%, group A) patients have survived and seven (29.2%, group B) have died. Birthweight and Apgar Scores in group A were significantly higher than in group B. The ratio of GAP (the distance of the location of the blind pouch from the ends of the upper and lower esophagus) to body length in group B was significantly higher than in group A. The birthweight and Apgar Scores in group A were significantly higher than in group B. When the authors compared their sample of cases by means of the Waterston classification, the Montreal classification and the Spitz classification, there were statistically significant differences between the results using the Waterston classification and the results using to the Spitz classification. CONCLUSION: For the cases of EA surgery that were examined, the authors concluded that bodyweight at birth and the existence of pre-surgery respiratory system complications have a significant effect on post-surgery recovery, and that results appear to indicate the importance of classification using the Waterston classification and Spitz classification as a means of assessing the degree of risk. Results also appeared to indicate that the control of Respiratory Distress Syndrome throughout both the pre-surgery and post-surgery periods is critical.     

Influence of congenital heart disease on management of oesophageal atresia

Congenital heart disease (CHD) is the commonest abnormality associated with oesophageal atresia, occurring in about 20% of cases. Echocardiography should be performed prior to repair of the atresia to identify CHD and lateralise the aorta. Knowledge of the anatomical type and physiological consequences of the CHD enables a co-ordinated plan of management. In patients who are non-duct-dependent for systemic or pulmonary blood flow the oesophagus can be repaired early while pulmonary vascular resistance is high; definitive treatment of the CHD is undertaken later. Duct-dependent lesions usually can be temporarily palliated with prostaglandin E₁ infusions commenced prior to repair of the atresia. It is extremely rare that palliative or reparative cardiac surgery is required prior to division of the tracheo-oesophageal fistula and repair of the oesophageal atresia. Offprint request to: S. W. Beasley     

Experience of decortication for restrictive hemodynamics in adults with congenital heart disease

We treated four postoperative adults with congenital heart disease with severe restrictive hemodynamics (RH), and performed decortication (DC) with the anticipation of some relief of the RH. The catheterizations before DC showed high central venous, and right and left ventricular end‐diastolic pressures with “dip‐and‐plateau” pressure waveforms in the right and left ventricles. Upon myocardial histopathologic examination, moderate myocardial fibrotic change was demonstrated in two of three cases. DC led to decrease in type B natriuretic peptide levels in all cases, resulting in a decline in the central venous, right and left ventricular end‐diastolic pressures in three cases. Successful DC‐related relief of RH, dilatation of the ventricles with decline in central and end‐diastolic pressures, was observed in only one case. Our limited DC‐related hemodynamic improvement indicates a complexity of the severe RH, which may represent a unique intractable heart failure pathophysiology in intractable postoperative adult congenital heart disease.     

Effects of ghrelin on growth and cardiac function in infants with congenital heart disease

Background: Ghrelin has effects on appetite and growth. Recent reports suggest effects on cardiac function, but no study has evaluated the ghrelin levels of congenital heart disease (CHD) infants with heart failure. The purpose of the present study was therefore to investigate the relationship between ghrelin level and growth and cardiac function in CHD infants. Methods: Twenty‐eight infants with CHD were eligible for the study. Blood samples were obtained at the time of insertion of intracardiac catheter and correlation was examined between ghrelin plasma level and anthropometric parameters, including z score of height and weight, body mass index (BMI), and %bodyweight gain rate, severity of heart failure, and the levels of leptin and insulin‐like growth factor‐1. Results: In the CHD group, active ghrelin (A‐Ghr) had a significant negative correlation with z score of bodyweight, and a significant positive correlation with cardiac function. There were no correlations, however, with height and BMI. A‐Ghr levels were significantly higher in the high heart failure index score group. Significant correlation between A‐Ghr and desacyl‐ghrelin in the CHD group was observed. Conclusions: A‐Ghr is involved in cardiac function and has little effect on their physique in infants with CHD.     

先天性食管闭锁新生儿肺部感染病原菌及药敏分析

目的 探讨患先天性食管闭锁(CEA)新生儿肺部感染的病原及其药敏情况.方法 回顾性分析2004年1月至2014年9月收治的CEA患儿的临床资料.结果 55例患儿纳入最终研究,共进行104次痰培养检查,检测出细菌112株,前5位的革兰阴性杆菌包括铜绿假单胞菌36株,肺炎克雷伯菌肺炎亚种29株,鲍曼不动杆菌19株,大肠埃希菌9株,嗜麦芽窄食单胞菌6株;革兰阳性球菌仅5株,溶血葡萄球菌、草绿色链球菌各2株,金黄色葡萄球菌1株.药敏分析显示,革兰阴性杆菌对半合成青霉素类及部分的头孢类抗生素敏感性<50%,对碳青霉烯类、氨基糖苷类及喹诺酮类抗菌药物敏感性>80%.革兰阳性球菌对万古霉素、替考拉林的敏感性为100%.结论 CEA患儿合并的肺部感染主要以革兰阴性杆菌为主,对半合成青霉素类及部分的头孢类抗生素敏感性较低,对碳青霉烯类、氨基糖苷类及喹诺酮类抗菌药物仍保持较高的敏感性.CEA患儿所并发的革兰阳性球菌感染对万古霉素、替考拉林仍保持较高的敏感性.     

新生儿重症先天性心脏病患儿的术前处理

目的：分析新生儿重症先天性心脏病的流行病学及临床特征,探讨其术前治疗的要点。方法回顾性分析2014年6月至2015年6月我院心外科重症监护室收治的新生儿重症先天性心脏病病例,总结其病种分布和主要临床表现,术前治疗的要点,插管和手术的指征及其转归。结果期间共收治96例新生儿期重症先天性心脏病患儿,大动脉转位为主要病种(包括室间隔完整和伴有室间隔缺损),占全部病例的49%,严重紫绀为就诊时的主要症状,占全部病例的62.5%,其次为心力衰竭,占全部病例的33.3%。87例患儿于术前插管,其中入院后即刻予插管的41例,入院后24h内插管的40例。1例主动脉弓中断患儿术前死亡。所有患儿均于住院期间接受手术。结论大动脉转位是新生儿重症先天性心脏病的主要病种,紫绀是新生儿期重症先天性心脏病患儿的主要症状,术前治疗取决于不同先天性心脏病的解剖和血流动力学特点,严密监测内环境和代谢指标决定插管和适时的手术时机。     

重症监护病房中危重婴儿先心病急诊手术的意义

目的 为减少重症监护病房(PICU)中患儿的死亡率，提高先心病患儿的存活率及改善其预后，寻找可行途径。方法 将3年来我中心PICU收沽并施行急诊手术的60例小于1岁的先心病患儿的临床资料进行回顾性分析。结果 60例先心病急诊手术患儿，死亡6例(心衰、术后低心排各3例)，余均存活。结论 先心病急诊手术能改善危重先心病患儿的预后，降低死亡率。     

先天性食管闭锁的外科治疗

目的：探讨提高先天性食管闭锁手术成功率的措施。方法：对我院1982－2000年62例先天性食管闭锁进行回顾分析。结果：59例获得手术治疗的先天性食管闭锁患儿,死亡7例,吻合口瘘4例,食管狭窄6例。1994年后连续22例无死亡。结论：早期诊断,熟练轻柔的手术操作及严密、高质量的术后监护是提高成功率的关键。