儿童简单先天性心脏病直视手术后不预防性放置引流的临床研究(附200例报告)  

The Investigation of the Safety of the Right Pericardial Window Techniques Instead of the Pericardial Drainage after the Congenital Heart Diseases Surgery in Children

作　　者：唐幂[1] 熊炼[1] 赵天力[1] 杨进福[1] 吴忠仕[1] 黄灿[1] 龚医博[1] 孙国文[1] 张鸿[1] 杨一峰[1] 

机构地区：[1]中南大学湘雅二医院胸心外科,长沙410011

出　　处：《中国现代手术学杂志》2014年第4期295-297,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨儿童简单先心病直视手术后不预防性放置外科引流的可行性与安全性。方法先天性心脏病患儿200例,年龄1-5岁,经胸骨正中切口进行心脏直视手术,右侧心包开窗后不放置引流管关胸。术后观察临床表现以及恢复情况。术后随访一月。结果术后2周随访,4例患儿发现右侧胸腔中-大量积液,其中室间隔缺损2例,房间隔缺损2例,均重新入院,行右侧胸腔闭式引流术。首日引流量为300-800 ml,总引流量为400-1 500 ml,引流时间3-7 d。4例患儿术后1月复查均未再发现心包和胸腔积液。结论儿童简单先天性心脏病直视手术后患儿,通过实施右侧心包开窗,可以不预防性放置外科引流。该技术能够避免外科引流所引起的疼痛及相关并发症,有利于术后护理和康复;能够避免因放置外科引流管所引发的不良医疗事件;能够避免术后急性心包填塞,预防迟发性心包积液可能导致的心包填塞。Objective To investigate the safety of the right pericardial window techniques instead of the pericardial drainage after the congenital heart diseases surgery in children. Methods There were 200 cases with congenital heart diseases, aging from 1 to 5 years old, received the cardiac surgery with median sternotomy. The right pericardial window techniques were used instead of the pericardial drainage after the congenital heart diseases surgery. Patients were followed up for one month and the cardiac ultrasound was applied to evaluate the safety. Results In the 2 weeks postoperative follow-up, 4 cases were found moderate to large amount of pleural effusion. And all the 4 cases received closed thoracic drainage for 3 - 7 days with a total of 300 - 1 500mL Conclusions It is safe for the children receiving the heart surgery without a preventive surgical drainage but opening the right pleural, which can reduce the complications arising from the surgical drainage such as pain and so on. What＇s more, it is able to prevent the delayed pericardial effusion.

关 键 词：心脏外科手术 心包造口技术 引流术 儿童 

分 类 号：R726.5[医药卫生—儿科]