精氨酸血管加压素在心肺复苏中的应用

精氨酸血管加压素(AVP)临床用途广泛,其在心肺复苏方面的应用正日益受到重视.作为交感神经系统和肾素-血管紧张素系统的后备,AVP对于危重患者的循环稳定起到至关重要的作用.目前大多数动物实验和临床研究均提示,AVP单用或联合其他抢救药物应用可以提高心肺复苏的成功率.儿童心肺复苏中应用AVP也取得积极成果.然而该药大剂量应用时可以出现局部缺血坏死等不良反应,同时应用该药进行心肺复苏后的中枢神经系统功能评估仍较难实施.     

先天性心脏病术后延迟关胸患儿程序式喂养的护理

总结5例复杂性先天性心脏病术后延迟关胸患儿程序式喂养的护理经验。护理要点包括：由儿童心脏病专家、心胸外科医生、心脏专科护士、营养师、胃肠病专家、康复治疗专家联合制订程序式喂养方案;微量喂养以维持其肠道功能;肠道功能评估后尽早启动肠内营养,初始喂养量设定为1~2 ml/（kg·h）;联合使用腹围测量（1次/12 h）、肠鸣音及胃肠道症状评估喂养不耐受;有序规律地推进肠内营养的实施,持续监测患儿的营养状况,每周监测2次体重、1次身长。本组均顺利关胸,达到全量经口喂养,病情缓解后出院。     

经右室穿刺肺动脉瓣球囊扩张治疗室间隔完整型肺动脉闭锁

目的 评价经右心室穿刺肺动脉瓣球囊扩张杂交手术治疗室间隔完整型肺动脉闭锁的早期治疗结果.方法 6例室间隔完整型肺动脉闭锁患儿接受右心室穿刺肺动脉瓣球囊扩张杂交手术.术前平均经皮氧饱和度(71±10)%.结果 全组无死亡及围术期并发症发生.术后经皮氧饱和度为(89±5)%;右室-肺动脉压差为(19±11)mm Hg.随访(4±3.6)个月,跨肺动脉瓣压差(45±42)mm Hg,1例术后再次行经导管肺动脉瓣球囊扩张.结论 对于右心室发育良好的室间隔完整型肺动脉闭锁,本术式早期疗效满意,安全性较高,术后肺动脉瓣反流少,可以促进右心室的发育.

Abstract：

Objective To evaluate the early outcomes of balloon valvuloplasty via right ventricle pulmonary valve for the treatment of pulmonary atresia with intact ventricular septum in children.Methods Methods Between January 2010 and December 2010, 6 patients were diagnosed with pulmonary atresia with intact ventricular septum, and underwent balloon valvuloplasty via right ventricle pulmonary valve at this center. Of the 6 patients, the mean body weight was 3. 8 ± 1.6 kg, the mean transcutaneous oxygen saturation was 71 ± 10%, and the mean age was 56 ± 45 days. All of the 6 patients had tripartite right ventricles. Their tricuspid valve z-scores ranged from -2 to 2. 2 (mean zscore: 0. 4 ± 1. 5). Results During operation, the mean size of the balloons used was 7. 3 ± 1. 2 mm,the ratio of the balloon size to pulmonary valve ring was 1.0 ± 0. 1, the pressure gradient between right ventricle and main pulmonary artery was 19 ± 11 mmHg, the ratio of forward flow from right ventricle to that from ductus arteriosus was 0. 35 ± 0. 06. After surgery, the mean ventilation time was 3. 2 ± 1.0 days, and mean ICU stay was 16 ± 5 days. The post-operative transcutaneous oxygen saturation was 89 ± 5%. The patients were followed up for 4 ± 3. 6 months. No death and post-operative complications were noted. One patient underwent interventional balloon valvuloplasty 2 weeks after the first surgery. The transcutaneous oxygen saturation on last follow-up was 85 ± 6%, which was significantly improved after surgery (t = -2. 66, p = 0. 045). The postoperative pressure gradient between right ventricle and main pulmonary artery was 45 ± 42 mmHg. Four of the 6 patients had pulmonary regurgitation, 3 of whom were mild and 1 was moderate. Tricuspid valve z-scores (mean, 0. 5± 1) also improved compared with that before procedure (t = -3. 36, p = 0. 02). Conclusions Balloon valvuloplasty via right ventricle pulmonary valve is safe and effective to treat the pulmonary atresia with intact ventricle septum in children.     

儿童先天性二尖瓣疾病的外科治疗及中期随访研究

目的探讨儿童先天性二尖瓣疾病外科手术的疗效及中期随访结果分析。方法回顾分析2009年1月至2017年12月在复旦大学附属儿科医院心血管中心接受二尖瓣成形术的患儿92例。其中,二尖瓣狭窄患儿26例(二尖瓣狭窄组),二尖瓣关闭不全患儿66例(二尖瓣关闭不全组);男44例,女48例;手术年龄为(42.55±40.57)个月,范围为1个月至14岁,22.8%(21/92)患儿的年龄<1岁。结果4.3%(4/92)的患儿于手术早期死亡,3.3%(3/92)的患儿在随访期间死亡,总病死率为7.6%。术后所有患儿的心功能分级改善明显,Ⅲ级3例,余均在Ⅱ级及以上,随访时间为(42.72±29.66)个月,随访时间范围为3~104个月。随访期间11例患儿共接受了17次再手术,所有患儿的再手术率为12.0%(11/92)。二尖瓣狭窄组与二尖瓣关闭不全组在生存率及免除再手术率的Log Rank分析中,差异无统计学意义。所有患儿中<1岁的患儿较>1岁的患儿具有更高的病死率(P=0.045)及再手术率(P=0.039),差异均具有统计学意义。结论二尖瓣成形手术对于治疗先天性二尖瓣疾病的效果显著。但婴幼儿,特别是年龄<1岁的患儿,先天性二尖瓣疾病的修补手术仍面临着巨大挑战。虽然部分患儿需多次手术,瓣膜成形术仍是再手术时首要考虑的手术方式。     

成功救治联体儿并复杂先天性心脏病1例

联体儿 女,胎龄36+5周,于2009年12月1日经剖宫产娩出.出生总体重5895 g,生后人工喂养.查体:两婴相向,剑突骨性相连,剑突下至脐部腹壁相连,长约9 cm.各自有完整的头颅、四肢(图1),各自神经系统检查无异常发现,四肢感觉、运动良好,肌力、肌张力正常,外生殖器和肛门正常独立存在.