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目的总结婴幼儿先天性心脏病合并肺动脉高压的手术及围术期处理经验。方法45例3岁以下的先天性心脏病合并肺动脉高压患儿施行外科手术治疗,其中接受体外循环手术36例,剖左胸动脉导管结扎术9例;围术期采用小儿心脏内、外科,麻醉、体外循环和术后监护等多学科协作的综合治疗。结果全组术后死亡3例,病死率为6.7%。术后主要并发症包括:低心排综合征、呼吸衰竭、心律失常、肺部感染及出血等。死亡原因为重度低心排综合征,肺动脉高压危象等。结论婴幼儿合并肺动脉高压的先天性心脏病一旦确诊就应尽早手术,但对术前有肺部感染或心衰,营养不良的患者,应积极控制感染和心衰,改善营养状况,提高手术耐受力;小儿心脏内、外科,麻醉科、体外循环和术后监护等的镶嵌治疗是手术成功的重要保证。
Objective To summarize the experience of perioperative management and surgical treatment of congenital heart disease complicated with pulmonary hypertension in infants and young children. Methods Forty-five children under 3 years of age with congenital heart disease complicated with pulmonary hypertension underwent surgery. Among them, 36 cases underwent cardiopulmonary bypass and 9 cases underwent catheterization of the left thoracic artery. Perioperative period, pediatric patients underwent cardiac surgery, anesthesia , Cardiopulmonary bypass and postoperative care and other multidisciplinary collaboration of comprehensive treatment. Results All patients died in 3 cases, the mortality rate was 6.7%. The main postoperative complications include: low cardiac output syndrome, respiratory failure, arrhythmia, pulmonary infection and bleeding. Cause of death for severe low cardiac output syndrome, pulmonary hypertension crisis. Conclusions Infants and young children with pulmonary hypertension complicated by congenital heart disease should be treated as soon as possible. However, patients with preoperative pulmonary infection or heart failure and malnutrition should be actively controlled for infection and heart failure, improve their nutritional status and improve the surgical tolerance Force; pediatric heart, surgery, anesthesiology, cardiopulmonary bypass and postoperative care and other inlaid treatment is an important guarantee for the success of the operation.