摘要
目的:分析我院59例体质量小于6kg的先天性心脏病并肺动脉高压患儿的临床资料,总结低体质量的先天性心脏病并肺动脉高压患儿的围手术期处理经验。方法:把握好手术时机;术前降低肺动脉压力,增加心肌能量储备功能;术中注意保护肺脏和心肌,体外循环后采用改良超滤法;术后予血管活性药物,前列腺素E1、一氧化氮吸入,予Siemens300A呼吸机、Babylog8000呼吸机、Maquet Servo呼吸机辅助呼吸。结果:57例患儿痊愈出院,在住院期期间平均肺动脉压有不同程度下降,12例出现并发症,为肺不张、肺炎、胸腔积液、急性肾功能衰竭、低心排出量、心律失常。死亡2例,1例患儿为术后出现肺水肿、肺出血,死于呼吸衰竭、循环衰竭;1例患儿死于低心排出量。结论:合理的围手术期处理是低体质量的先天性心脏病并肺动脉高压患儿手术成功的关键。
Objective To summarize the experience in perioperative management of low-body-weight infants with congenital heart disease （CHD） and pulmonary hypertension （PH） by analyzing the clinical data of 59 infants weighing less than 6kg with CHD and PH in our hospital. Methods Pulmonary arterial pressure in the infants was perioperatively reduced and the energy reserve of the myocardium was enhanced. The lungs and the myocardial were properly protected and modified uhrafihration was used after cardiopulmonary bypass （CPB） during surgery. Vasoactive drugs, prostaglandin E1, and NO were administrated postoperatively and mechanical ventilation was also applied. Results 57 infants recovered with a decrease in MAPA and were discharged from hospital but one died from respiratory and circulatory failure secondary to pulmonary edema and hemorrhage and another one died from low cardiac output. Complications including atelectasis, pneumonia, pleural effusion, renal failure low cardiac output, and arrhythmias occurred in 15 infants. Conclusion Proper perioperative management is key to a successful surgery for low-weight infants with CHD and PH.
出处
《实用医学杂志》
CAS
2008年第10期1732-1734,共3页
The Journal of Practical Medicine
关键词
心脏病
高血压
肺性
人体质量指数
手术期间
Heart diseases Hypertension, pulmonary Body mass index Intraoperative period
