婴幼儿完全性房室通道矫治术后快速康复  

Fast Track Treatment in Young Children Following Atrioventricular Septal Defect Repair

作　　者：曾敏[1] 王旭[1] 李守军[2] 晏馥霞[3] 赵举[4] 刘迎龙[2] 闫军[2] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院小儿心脏外科中心PICU,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院小儿心脏外科,北京100037 [3]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,北京100037 [4]中国医学科学院北京协和医学院阜外心血管病医院体外循环科,北京100037

出　　处：《中国胸心血管外科临床杂志》2010年第6期459-461,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十一五"国家科技支撑计划资助项目(2006BAI01A08)~~

摘　　要：目的探讨婴幼儿完全性房室通道(CAVSD)伴肺动脉高压(PAH)患者矫治术后快速康复(fast track,FT)治疗的可行性和安全性。方法自2006年1月至2009年3月阜外心血管病医院小儿心脏外科中心共收治CAVSD矫治术后婴幼儿患者51例,男24例,女27例;年龄4~36个月(12.5±8.9个月)。均按照快速康复临床管理路径行快速康复治疗。分析患者二次气管内插管率,住PICU时间,比较手术前后肺动脉压下降程度。结果 51例患者中有21例(41.17%)行快速康复治疗,均在术后8 h内拔除气管内插管。术后患者平均肺动脉压(MPAP)显著下降(39.59 mm Hg vs.24.50 mm Hg,t=5.514,P<0.05),住PICU时间2.05±0.87 d(18 h^3 d)。1例48 h后因肺部感染二次气管内插管,插管原因与快速康复无关。随访3~6个月,21例患者心功能良好,无二次手术和死亡患者。结论快速康复治疗对部分伴PAH的CAVSD矫治术患者是安全、可行的,能够减少住ICU的天数;但对重度PAH患者的快速康复治疗需要更大样本的研究。Objective To investigate the safety and feasibility of fast track（FT） treatment in young children with atrioventricular septal defect（CAVSD） and pulmonary artery hypertension（PAH） following surgical repair.Methods A total of 51 young children patients including 24 boys and 27 girls with age at 12.5±8.9 months from 4 to 36 months,underwent CAVSD repair in the pediatric surgery department of Fu Wai Hospital from January 2006 to March 2009.Among them,21 patients were administered FT management.PICU length of stay and the rate of reintubation were analyzed retrospectively and the decrease of pulmonary artery pressure（PAP） after operation was also measured.Results Twenty-one patients under FT treatment were extubated within 8 hours after operation.The mean pulmonary artery pressure（MPAP） decreased significantly after surgery（39.59 mm Hg vs.24.50 mm Hg,t=5.514,P0.05）.PICU length of stay was 2.05±0.87 d（18 h-3 d）.One patient was reintubated due to lung infection,which had nothing to do with the FT treatment.During the follow-up which lasted for 3 to 6 months,21 patients had good heart function with no reoperation or death.Conclusion FT treatment is safe and feasible to some CAVSD patients associated with PAH,and shorter PICU length of stay can be achieved.The validation of FT model for the CAVSD patients with severe PAH needs research with large sample.

关 键 词：快速康复 完全性房室通道 先天性心脏病 肺动脉高压 

分 类 号：R726.5[医药卫生—儿科]