婴幼儿先天性心脏病围术期处理  

Perioperative management of congenital heart defects in infants and young children

作　　者：王涛[1] 林红[2] 江泽熙[2] 何琼[2] 刘琼[2] 

机构地区：[1]武汉大学医学院 [2]湖北省武汉市儿童医院心胸外科,湖北武汉430016

出　　处：《临床儿科杂志》2007年第2期144-146,共3页Journal of Clinical Pediatrics

摘　　要：目的总结10 kR以下婴幼儿先天性心脏病围术期处理经验。方法共入选患儿420例,男245例,女175例;年龄1-36个月,平均年龄(12．5±10．9)月;体重2．5-10 kg,平均(7．5±2．2)kg;病种有VSD+ PH,VSD+ASD+PH,VSD+ASD+PDA+PH,TOF,DORV,TAPVD,TA,TGA等。术前完善各项检查,积极治疗肺炎、心力衰竭、贫血。术后早期根据患儿肺部病变情况,动态调整呼吸机参数,适当加用PEEP,适时选择拔管时机。结果420例患儿中出现术后并发症82例(19．5％),死亡33例(7．9％),主要原因为低心排、低氧血症、心律失常、肾功能衰竭及多器官功能衰竭。结论完善术前诊治水平,正确掌握手术适应证和时机;加强围术期呼吸和循环系统管理,有助于减少术后并发症,提高治愈率和疗效。Objectives To sum up the perioperative management of congenital heart defects （CHD） in infants and young children with body weight less than 10 kg. Methods Clinical data of 420 patients with CHD was retrospectively analyzed. Results The 420 patients aged （2.5 ± 10.9） months with body weight of （7.5 ± 2.2） kg had different kinds of congenital heart defects as VSD ＋ PH, VSD ＋ ASD ＋ PH, VSD ＋ ASD ＋ PDA ＋ PH, TOF, DORV, TAPVD, TA, TGA. Before operation all examinations were performed and rigorous measures were adopted to correct preoperative pneumonia, heart failure and anemia. During early postoperative period, respiratory parameters of mechanical ventilation were adjusted, PEEP were applied selectively and removed according to patients＇ pulmonary function. To choose extubation opportunity at the right moment. 82 cases （19.5 %） had postoperative complications and 33 cases （7.9 %） died mainly due to low cardiac output syndrome, hypoxia, arrhythmias, renal failure and. multiple organ failure. Conclusions To perform all examinations before operation, choose appropriate opportunity and indication for operation, reinforce the porioperative management of respiration and circulation will be helpful to decrease postoperative complications and increase cure rate.

关 键 词：婴幼儿 围术期处理 先天性心脏病 

分 类 号：R726.5[医药卫生—儿科]