33例肺动脉吊带患儿术后治疗

目的总结肺动脉吊带(PAS)患儿术后治疗策略及临床治疗经验。方法纳入我科2006年11月至2013年12月期间收治的33例PAS患儿,单纯PAS及合并动脉导管未闭患儿20例,合并有心内畸形患儿13例。回顾性分析患儿术后主要治疗方法包括呼吸机及无创持续气道正压通气(NCPAP)辅助呼吸、血管活性药物支持心功能,收集相关临床资料进行分析。结果患儿呼吸机辅助时间2⁸65 h;其中4例(12.1%)需要再次气管插管;7例(21.2%)拔除气管插管后需要NCPAP辅助,应用时间为1865 h;其中4例(12.1%)需要再次气管插管;7例(21.2%)拔除气管插管后需要NCPAP辅助,应用时间为1¹5 d。20例单纯PAS患儿中有4例(20.0%)进行了小剂量、短时间的血管活性药物的支持,而13例合并有心内畸形、需要心内手术操作的患儿中有9例(69.2%)在监护室内进行了血管活性药物的支持(P<0.01)。患儿ICU滞留时间为115 d。20例单纯PAS患儿中有4例(20.0%)进行了小剂量、短时间的血管活性药物的支持,而13例合并有心内畸形、需要心内手术操作的患儿中有9例(69.2%)在监护室内进行了血管活性药物的支持(P<0.01)。患儿ICU滞留时间为1³9 d;其中2例(6.1%)重返ICU。33例患儿手术均成功,除1例因气道狭窄明显、脱机困难,家长放弃治疗外,其他32例患儿均康复出院。结论术后尽早脱离气管插管、必要的NCPAP支持及血管活性药物的适当应用,是保证PAS患儿术后康复的主要治疗措施。

Postoperative treatment for 33 cases of pulmonary artery sling

Objective To summary the postoperative treatment strategies for patients with pulmonary artery sling. Methods The primary treatment strategies in post-operative stage were analyzed and compared. The main methods include mechanical ventilation, noninvasive continuous positive airway pressure （NCPAP） and cardiac drugs. Results The patients needed mechanical ventilation for 2-865 hours. Re-intubation happened in 4 cases. Seven patients needed NCPAP for 1-15 days after extubation. Thirteen patients treated by cardiac drugs. The patients have been in ICU for 1-39 days, and 2 children returned back because of dyspnea. All the operations were successful, and 32 patients recovered except one was abandoned by his parents because of the severe tracheal stenosis. Conclusions Extubate as early as possible, using NCPAP if necessary, and cardiac drugs are the main treatments for PAS patients after the successful operations.