儿科重症监护病房危重先天性心脏病87例术前保守治疗效果分析

Preoperative Expectant Treatment of 87 Patients with Critical Congenital Heart Diseases in Pediatric Intensive Care Unit

目的探讨儿科重症监护病房中危重先天性心脏病(先心病)患儿术前保守治疗的效果。方法2005年9月—2008年2月我科收治了87例危重症先天性心脏病患儿,根据临床特点和实验室检查结果进行内科综合治疗,观察术前保守治疗的临床效果。结果87例患儿中18例因呼吸衰竭(11例)或频繁缺氧发作(7例)使用机械通气,呼吸机使用时间为3h～5d。53例非青紫型先心病患儿在控制肺部感染、强心、降低肺动脉高压和呼吸机支持等内科治疗后除1例心房、心室和大血管多个水平分流致肺部感染严重、心力衰竭难以控制而死亡外,其余患儿经随即外科手术纠治心内畸形后均存活。34例青紫型先心病患儿中7例死亡。结论及时、有效的术前内科保守治疗,包括控制肺部感染、强心治疗、降低肺动脉高压和呼吸机支持至关重要,不但能使患儿生存至外科手术年龄,并能使患儿在较好状态下接受手术治疗,减少手术并发症及降低病死率。

Objective To explore the effect of expectant treatment on critical congenital heart diseases（CHD） in pediatric intensive care unit（PICU） before operation.Methods Eighty-seven child patients with critical CHD admitted from September 2005 to February 2008 were given a comprehensive medical treatment based on clinical characteristics and laboratory test results.The clinical effect of expectant treatment was observed before operation.Results Eighteen patients used mechanical ventilation respirator due to respiratory failure（11 cases） or frequently anoxic seizures（7 cases）,3 h～5 h.Of 53 patients non-cyanotic CHD,all survived after surgical correction of cardiac malformation except that 1 died because of severe lung infection and heart failure caused by multiple levels of diffluence of heart atrium,ventricle and great vessels after medical treatment such as lung infection control,cardiotonic,pulmonary hypertension reduction,respirator support,etc.Seven of 34 cyanotic CHD patients died.Conclusion Timely and effective preoperative medical conservative treatment including pulmonary infection control,cardiac treatment,pulmonary hypertension reduction and respiratory support is of great importance,not only making child patients live to surgical age,but also making child patients receive surgical treatment in a better state and reducing operative complications and mortality.