儿童先心病术后并发症心肌血肿:单中心经验  

Intramycardial hematoma following congenital cardiac surgery in children:a single-center experience

作　　者：陆叶 刘徐妹 王莉[1] 虢艳 李健茹 梁小碧 廖妍 马力[2] 陈伟丹[2] Lu Ye;Liu Xumei;Wang Li;Guo Yan;Li Jianru;Liang Xiaobi;Liao Yan;Ma Li;Chen Weidan(Department of echocardiography,Guangzhou Women and Children’s Medical Center,Guangzhou Medical University,Guangzhou,510623,China;Cardiovascular Surgery,Guangzhou Women and Children’s Medical Center,Guangzhou Medical University,Guangzhou,510623,China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心心脏彩超科,广州510623 [2]广州医科大学附属广州市妇女儿童医疗中心心脏外科,广州510623

出　　处：《中华胸心血管外科杂志》2024年第11期657-659,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结及分析本中心8例先天性心脏病术后并发症心肌血肿的临床表现及特征。方法检索2008~2023年于广州市妇女儿童医疗中心确诊的先心病术后心肌血肿8例。患儿均在本院行先心病手术。结果患儿手术年龄(13±15)个月,体质量(7.8±3.5)kg。术前诊断多为室间隔缺损。8例血肿中6例发生在室间隔,2例发生在左室游离壁。2例ECMO辅助治疗,术后6~7天撤除。8例患儿均由床边经胸超声心动图检查发现心肌血肿。最终全部患儿均顺利出院。6例心肌血肿吸收时间均为1个月左右,平均(33.5±4.6)天,左心室射血分数(LVEF)0.60±0.09。1例随访至术后3个月血肿尚未完全吸收,另一例失访。结论心肌血肿是先心病术后罕见的并发症,血肿是动态变化的过程,多数病例心肌血肿在1个月左右吸收。对于血流动力学不稳定的患者,ECMO可作为治疗手段,为血肿的吸收创造时机。Objective To summarize the clinical features of 8 cases with intramycardial hematoma(IMH)following congenital cardiac surgery in children.Methods We retrospectly searched 8 patients with intramycardial hematoma after congenital cardiac surgery in Guangzhou Women and Children’s Medical Center from 2008 to 2024.Results Mean age and mean weight at surgery were(13±15)months and(7.8±3.5)kg respectively.6 of 8 cases were interventricular septal hematoma.In the other 2 patients,intramycardial hematoma was located in left ventrical free wall.All IMH were postoperatively detected by transthoracic echocardiaography.Two patients were managed with ECMO intraoperatively.Finally,all patients were discharged successfully with good clinical results.Mean time to IMH resolution in six patients was(33.5±4.6)days and mean left ventricular ejection fraction(LVEF)was 0.60±0.09.Another patient was followed up for 3 months and the IMH was not absorbed.One patient was lost to follow-up.Conclusion IMH is a rare complication after congenital heart disease.The absorption of hematoma is a dynamic process and mean time to IMH resolution is about 1month.In IMH patients with hemodynamic instability,ECMO can be a good treatment to create opportunities for hematoma absorbtion.

关 键 词：心肌血肿 室间隔血肿 先心病手术 

分 类 号：R726.5[医药卫生—儿科]