婴幼儿先天性心脏病术后处理及监护

Post-Operative Treatment and Intensive Care of Infants with Congenital Heart Disease

目的探讨婴幼儿先天性心脏病(CHD)术后处理及监护经验。方法回顾性分析1998年5月-2006年4月本科收治264例CHD婴幼儿术后处理及监护资料。其中根治性手术256例,姑息性手术8例。结果术后早期死亡16例。其中法洛四联症(TOF)8例,完全型房室管畸形2例,室间隔缺损(VSD)并肺动脉高压(PH)3例,三尖瓣闭锁、单心室、永存动脉干各1例。死亡原因包括低心排、急性肾衰竭、Ⅲ度房室传导阻滞(AVB)、肺部感染、呼吸衰竭、心律失常等。完全性肺静脉异位引流1例术后因顽固性高碳酸血症自动出院;房间隔缺损(ASD)并动脉导管未闭(PDA)1例术后1 a PH不能缓解,死于顽固性心力衰竭;TOF 1例行姑息性流出道疏通术后3 a,再行根治手术后死于肺出血。健康生存245例,心功能Ⅰ级233例,Ⅱ级12例。结论术后正确的呼吸系统管理,系统的心电监护、积极处理心律失常和低心排、营养支持等是提高CHD患儿术后成活率的重要措施。

Objective To explore post - operative treatment and intensive care of infants with congenital heart disease（CHD）. Methods Clinical data of post - operative treatment and intensive care in 264 infants with CHD were analyzed retrospectively from May. 1998 to Apr. 2006. Among them,256 cases underwent radical operation, and 8 cases with palliative operation. Results Sixteen cases died early. Among them, after operation, there were 8 cases with Fallot＇s syndrome ,2 cases with complete atrioventricular canal anomalous ,3 cases with ventricular septal defect（VSD） and pulmonary hypoplasia（ PH ）, 1 case with tricuspid atresia, 1 case with single ventricle, and 1 case with persistent truncus arteriosus. Causes of death include low cardiac output, acute renal failure, degree of HI atrioventricular block （ AVB ）, lung infection, respiratory failure and arrhythmia. One ease with complete pulmonary vein ectopia was discharged due to post - opertative refractory hypercapnia; 1 case with atrial septal defect（ASD） and patent ductus arteriosus（PDA） died of refractory heart failure due to high pulmonary arterial pressure 1 year after operation ; 1 case with tetralogy of Fallot died of lung hemorrhage after radical correct operation followed by palliative outflow tract deoppilant operation. Of them 245 cases alive,there were 233 cases with heart function grade Ⅰ , 12 cases with grade Ⅱ. Conclusion Correct management of respiratory system, systemic electrocardial care, handling with arrhthymia on time,low cardiac output and nutritional support are the important measures in improving survival rate of infants with CHD.