婴幼儿先天性心脏病合并重症肺炎的治疗策略

目的：研究先天性心脏病婴幼儿合并重症肺炎的不同治疗方法及预后，探讨最佳的治疗策略。方法： 中南大学湘雅医院儿科2014年1月至12月共收治27例先天性心脏病合并重症肺炎的患儿，其中男18例，女9例；年龄 2.0~19.0(5.9±4.3)个月，体重3.3~10.0(5.8±1.8) kg；均采用完全控制肺部感染后再考虑手术治疗的策略(内科治疗组)。 2015年1月至12月共收治29例先天性心脏病合并重症肺炎的患儿，其中男15例，女14例；年龄2.0~27.0(6.1±3.9)个月， 体重3.1~8.0(4.8±1.0) kg；积极采用抗生素及对症支持治疗，无明显改善则安排手术治疗(联合治疗组)。结果：内科治 疗组患儿住院时间为3~26(11±6) d，1例院内死亡。出院后有5例选择进一步手术治疗。联合治疗组患儿术前住院时间 1~21(10±6) d。联合治疗组患儿总的住院时间为14~48(24±9) d，手术后住院时间为6~35(14±7) d。随访30 d，联合治疗 组患儿有1例死亡，为术后当天死亡，病死率为3.4%。内科治疗组6例死亡，病死率为22.2%。结论：先天性心脏病合 并重症肺炎需要尽早手术治疗，矫正心脏畸形，减少肺部血流，有助于肺部感染的控制，减少病死率。儿科和心脏 大血管外科的积极合作是治疗这类患儿的有效保障。

Treatment strategies for congenital heart disease in infants with severe pneumonia

Objective: To observe the results of different treatment of congenital heart disease (CHD) complicated with severe pneumonia in infants. Methods: A total of 27 infants with CHD and severe pneumonia were admitt ed to the Department of Pediatrics, Xiangya Hospital from January 2014 to December 2014, of whom 18 were male and 9 were female. The average age was 2.0–19.0(5.9±4.3) months, with an average body weight of 3.3–10.0 (5.8±1.8) kg. Infants were treated with a strategy of complete control of the lung infection before surgery (internal medicine group). From January 2015 to December 2015, 29 infants with same condition were admitt ed, of whom 15 were males and 14 females. Th e average age was 2.0–27.0 (6.1±3.9) months, with an average body weight of 3.1–8.0 (4.8±1.0) kg. Infants were treated with a strategy of combined treatment (combined treatment group), in which early surgical treatment were performed after a short time antibiotics and supportive treatment. Results: One nosocomial death in internal medicine group, with an average hospital stay for 3–26 (11±6) d. Further surgeries were performed in 5 patients after discharge with no surgical death. The mean preoperative hospital stay in combined treatment group was 1–21 (10±6) d. The mean total hospital stay for combined treatment group was 14–48 (24±9) d and the mean postoperative hospital stay was 6–35 (14±7) d. One patient died soon after surgery in combined treatment group. Thirty-day follow-up found that no other patient died in combined treatment group, and 6 patients died in internal medicine group. The 30-day mortality was 3.4% in combined treatment group and 22.2% in internal medicine group (P<0.01). Conclusion: Infant congenital heart disease complicated with severe pneumonia requires early surgical treatment, which contributed to the control of pulmonary infection and reduce mortality.