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目的总结婴幼儿心肺转流(CPB)先天性心脏病术后出现交界性异位心动过速(JET)的诊治体会。方法 11例先天性心脏病婴幼儿于CPB术后6~20h诊断JET。原发疾病:室间隔缺损4例,法洛四联症5例,完全性肺静脉异位连接(心内型)1例,部分型房室隔缺损1例。诊断JET后的处理:镇静、呼吸机辅助呼吸;控制性降温,采用体表降温法将直肠温度降至33~35℃;静脉输注胺碘酮,维持心率于180次/分以下;快速洋地黄化;调整血管活性药物的用量。结果经上述处理后,11例患儿心律均转为窦性,循环稳定。术后1周复查心脏超声,左心室射血分数和左室短轴缩短率均低于术前,术后3个月恢复正常。结论婴幼儿先天性心脏病CPB术后JET对血流动力学影响大,早期控制性降温及应用胺碘酮等处理可有效减慢心率,使心律转成窦性。
Objective To summarize the diagnosis and treatment of borderline ectopic tachycardia (JET) in infants with cardiopulmonary bypass (CPB) after congenital heart disease. Methods 11 cases of congenital heart disease infants and young children diagnosed JET 6 ~ 20h after CPB. Primary disease: ventricular septal defect in 4 cases, tetralogy of Fallot in 5 cases, complete pulmonary vein ectopic connection (cardiac type) in 1 case, a partial atrioventricular septal defect in 1 case. After the diagnosis of JET treatment: sedation, ventilator-assisted breathing; controlled cooling, the body surface cooling method will rectal temperature dropped to 33 ~ 35 ℃; intravenous amiodarone, to maintain the heart rate at 180 beats / min or less; To yellow; adjust the amount of vasoactive drugs. Results After the above treatment, 11 patients with heart rhythm were converted to sinus, stable circulation. Cardiac echocardiography, left ventricular ejection fraction and left ventricular fractional shortening were all lower than preoperative one week after operation, and returned to normal at 3 months after operation. Conclusions Infantile congenital heart disease JET has a great influence on hemodynamics after CPB. Early controlled cooling and amiodarone treatment can effectively reduce heart rate and turn heart rhythm into sinus.