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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 feasibility and safety of prophylactic surgical drainage of children with simple congenital heart disease under direct vision surgery. Methods 200 cases of children with congenital heart disease, aged 1 to 5 years old, underwent open heart surgery with a median incision of the sternum, and the drainage tube was closed after the right pericardial fenestration. Postoperative observation of clinical manifestations and recovery. Follow-up January. Results Two weeks after the operation, four patients were found in the right side of the pleural cavity to a large number of effusion, ventricular septal defect in 2 cases, atrial septal defect in 2 cases, were re-admitted to the right side of the closed thoracic drainage. The first day of drainage is 300 ~ 800 ml, the total drainage of 400 ~ 1 500 ml, drainage time of 3 ~ 7 d. No recurrence of pericardial and pleural effusion was found in 4 children after 1 month of operation. Conclusions In children with simple congenital heart disease undergoing direct ophthalmic surgery, surgical drainage can be performed without prophylactic placement by opening the right pericardial window. The technology can avoid the pain caused by surgical drainage and related complications, is conducive to postoperative care and rehabilitation; to avoid the surgical drainage tube caused by the adverse medical events; to avoid postoperative acute cardiac tamponade, the prevention of delayed pericardial Fluid may cause tamponade.