小儿先天性心脏病术后严重消化道出血的诊疗

Diagnosis and therapy of gastrointestinal bleeding after operation of congenital heart disease

目的总结小儿先天性心脏病术后严重消化道出血的发病规律和治疗特点。方法分析阜外医院小儿心脏中心2007年4至9月经治的17例术后合并严重消化道出血患儿的临床资料。常规的止血治疗效果不满意者，静脉持续泵入生长抑素（思他宁）和垂体后叶素。结果术后合并严重消化道出血者均为复杂心脏畸形，以右心畸形为主。大于2岁者发病率最高。应用生长抑素6例，平均剂量（0．21±0．09）mg／h，应用垂体后叶素5例，平均剂量（0．29±0．13）U／h。1例开腹手术止血。经治疗患儿消化道出血均明显好转。2例肺动脉闭锁因肺出血死亡。结论复杂心脏畸形术后易发生严重的消化道出血。诊疗及时、规范。可以减少病死率。决定预后的关键因素是心脏畸形及其对全身器官系统的影响。

Objective To sum up the characteristics of mobidities and managements of gastrointestinal bleeding after operation of congenital heart disease. Methods Seventeen postoperative patients who suffered from severe gastrointestinal hemorrhage from April to September in 2007. When traditional managements failed, Somatostatin and Hypophysin would be given intravenously. Results Severe gastrointestinal bleeding all took place on patients with complex cardiac malformation and the majority was with right heart defects, more than 2 years. Six patients were given Somatostatin and 5 Hypophysin. One patient underwent abdominal operation because of hemorrhage. The bleeding were all cured after managements. Two patients died on account of lung bleeding. Conclusion Patients with complex malformation are prone to complicate with gastrointestinal bleeding after operation of congenital heart diseare. Rational managements can enhance the survival rate, but the kinds of anomalies and organ function are crucial.