术前呼吸机支持的先天性心脏病患儿的外科治疗  

Surgical Treatment for Congenital Heart Disease with Preoperative Ventilation in Children

作　　者：龚立[1,2] 姚文艳[1] 王涛[1] 汪力[1] 谢艳丽[1] 皮名安[1] 董念国[2] 

机构地区：[1]华中科技大学附属武汉市儿童医院心胸外科,武汉430016 [2]华中科技大学附属协和医院心外科,武汉430022

出　　处：《实用儿科临床杂志》2012年第23期1813-1815,1825,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的总结术前呼吸机支持的先天性心脏病(先心病)的外科治疗经验。方法回顾性分析2011年9月-2012年4月16例术前呼吸机支持的先心病患儿资料。其中男10例,女6例;年龄21 d～7个月,其中10例为2个月以下。术前6例因严重低氧血症、10例因肺炎导致呼吸衰竭上呼吸机治疗。术前呼吸机支持时间为1～20 d,16例均行手术治疗,根据病种不同,选择不同的手术及体外循环方式,14例选择解剖纠治,2例选择分期手术。结果主动脉阻断时间为(34.34±30.24)(24～93)min,体外循环时间为(54.28±60.43)(34～196)min,术后呼吸机支持时间为(98.21±100.36)(40～391)h,ICU滞留时间为(7.25±12.94)(4～19)d。术中死亡1例,术后死亡2例,3例均死于肺出血,其余痊愈出院。术后2例由于体外循环后血流动力学不稳定而延迟关胸、3例出现低心排出量综合征、3例需腹膜透析、1例乳縻胸术后1周行胸导管结扎后治愈。8例痰培养为阳性,其中5例术前痰培养已为阳性。无一例发生伤口或纵隔感染。结论术前呼吸机支持先心病手术干预风险高,并发症多,术后恢复慢。应尽量在未出现危重症状前手术治疗。Objective To summarize the surgical treatment approach for young children with congenital heart disease who required mechanical ventilation before cardiac surgery. Methods A retrospective review of a cohort of patients in our department from Sep. 2011 to Apr. 2012 was performed. The subjects study included 16 （ 10 male and 6 female） cases of congenital heart diseases supported with mechanical ventilation before cardiac surgery. Their ages ranged from 21 days to 7 months post - delivery. Among them 10 cases were less than 2 months old. Before the operations,all patients required tracheal intubation for mechanical ventilation（6 cases due to hypoxic seizures, 10 cases due to respiratory failure）. The duration of preoperative mechanical ventilation was from l to 20 days. Different types of surgical procedures and cardiopulmonary by passes（CPB） were performed according to the types of diseases. Anatomy correction was performed in 14 cases, while stageing operations were needed in 2 cases. Results The mean aortic cross clamp time was （ 34.34 ± 30.24 ） min （ ranging 24 - 93 min）, the mean CPB time was（ 54.28 ± 60.43 ） min （ranging 34 - 196 min）, the mean duration of postoperative ventilation was （98.21 ± 100. 36 ） hours （ranging 40 -391 hours）, and the mean ICU was （7.25 ± 12.94 ） days （ranging 4 -19 days）. One case died during the operation, and 2 cases died post - surgery, they all died of pneumorrhagia. The other 13 survivors were discharged with recovery. Two cases of them required delayed sternal closure because of unfavorable postbypass hemodynamics. Other morbidities in the immediate postoperative period included low cardiac output state （ n = 3 ） ,peritoneal dialysis （ n = 3 ）, chylothorax （ n = 1 ）, which were cured with thoracic duct ligation 1 week later. Eight patients had positive postoperative sputum bacterial cultures with the same organisms that were cultured preoperatively in 5 cases of them. There were no instances of wound infection or medias

关 键 词：术前 呼吸机支持 手术 先天性心脏病 并发症 

分 类 号：R726.5[医药卫生—儿科]