小儿急性化脓性心包炎围术期处理

THE PERIOPERATIVE MANAGEMENT OF ACUTE PURULENT PERICARDITIS IN CHILDREN

本文报道我院从１９８１～１９９１年为３８例小儿急性化脓性心包炎施行心包大部切除术，疗效满意，这与围术期处理关系密切，充分的术前准备和心包穿刺对提高患者手术的耐受性极为重要；我们认为一经确诊后即行手术.文中讨论了麻醉诱导期发生严重低血压和心脏骤停的紧急处理措施；并强调术中术后输血或血浆提高胶体渗透压，同期应用硝普钠和速尿减轻心脏前后负荷，以改善心脏功能.

Thirty-eight children with acute purulent pericarditis treated by pericadiectomy from1981 to 1991 were presented。 The treatment was effective and it was closely correlated with theperioperative management. Adequate preoperative preparation and pericardiocentesis to improve thepatient’s endurance to operation is of the upmost importance。 Once the diagnosis was estab- lished, the operation should be performed as soon as possible。 The emergency measures of surgicalmanagement of the severe low arterial blood pressure and cardiac arrest occurred in the course ofanaesthesia were discussed。 During operative and postopemtive period, the authors emphasize thatintravenous nitroprusside and diuretics are given to reduce ventricular preload andafterload in order to improve cardiac function and that blood or plasma is tranfused to increase colloid osmotic pressure.