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目的探讨延迟关胸技术在小儿复杂先天性心脏病手术中的应用价值。方法小儿复杂先天性心脏病术后延迟关胸79例,其中大动脉调转(Switch)术36例,法洛四联症(TOF)根治术25例,完全肺静脉异位引流(TAPVC)矫治术7例,心室内隧道外管道(Rastelli)术3例,姑息右室流出道疏通术2例,主动脉移植(Nikaidoh)术2例,双向上腔肺动脉连接(Gleen)术1例,主动脉弓部成形术2例,主肺动脉窗修补术1例。结果延迟关胸术后出现心肌水肿36例(45.57%),急性肾功能损害28例(35.44%),肺部感染28例(35.44%),创面严重出血22例(27.85%),肺部出血12例(15.19%),急性肝功能损害8例(10.13%),高度房室传导阻滞5例(6.33%),泌尿道感染2例(2.53%),灌注肺、深静脉血栓、麻痹性肠梗阻、膈肌麻痹、颅内高压、乳糜胸均1例(1.27%)。胸骨敞开时间平均为(62.2±9.3)h,73例(92.41%)成功延迟关胸并痊愈出院,6例(7.59%)死亡。结论延迟关胸术是一种帮助术后止血困难,度过术后心肌水肿高峰期、预防术后低心排综合征的简单、安全而有效的解决方法,并未增加伤口感染。
Objective To investigate the value of delayed closure technique in children with complicated congenital heart disease. Methods A total of 79 cases of delayed chest closure after complicated congenital heart disease were treated in our hospital. Among them, 36 cases underwent switch, 25 cases underwent TOF and 7 cases underwent complete pulmonary venous drainage (TAPVC) 3 cases of Rastelli, 2 cases of palliative right ventricular outflow tract debridement, 2 cases of Nikaidoh, 1 case of bilateral upper pulmonary artery ligation, 1 case of aortic arch angioplasty Cases, the main pulmonary artery window repair in 1 case. Results Thirty-six cases (45.57%) had myocardial edema after delayed thoracotomy, 28 cases (35.44%) had acute renal damage, 28 cases (35.44%) had pulmonary infection, 22 cases (27.85%) had severe hemorrhage, 12 cases (15.19%), 8 cases of acute liver damage (10.13%), 5 cases of atrioventricular block (6.33%), 2 cases of urinary tract infection (2.53%), pulmonary thrombosis, deep venous thrombosis, paralytic Ileus, diaphragmatic paralysis, intracranial hypertension, chylothorax were 1 case (1.27%). Sternal open time averaged (62.2 ± 9.3) h, 73 cases (92.41%) successfully delayed off the chest and discharged, 6 cases (7.59%) died. Conclusion delayed thoracotomy is a simple, safe and effective solution to postoperative hemostatic difficulties, to survive postoperative peak myocardial edema and to prevent postoperative low cardiac output syndrome without increasing wound infection.