30例完全性肺静脉异位引流患儿术后早期并发症分析及处理对策

The early postoperation complications and treatments in 30 children with total anomalous pulmonary venous connection

目的了解完全性肺静脉异位引流（total anomalous pulmonary venous connection，TAPVC）术后早期发生的并发症，总结处理对策。方法收集行TAPVC根治术后转入PICU监护的患儿30例，术后常规心电、血压、血氧饱和度监护，呼吸机辅助呼吸，并经镇静、止血、正性肌力药物治疗、利尿、扩血管、抗感染及对症等综合处理。有低心排血量表现时再加用肾上腺素或异丙肾上腺素。出现缓慢性心律失常时，予临时起搏器治疗。患儿术前即有重度肺动脉高压或术后判断有反应性肺动脉高压时予前列地尔或西地那非。结果30例患儿术后并发肺炎13例（43．3％），心律失常8例（26．7％），低心排血量综合征7例（23．3％），呼吸衰竭6例（20．0％），肺动脉高压4例（13．3％），肺水肿及肺不张各3例（10．0％），肺出血1例（3．3％）。术后早期死亡2例。ICU住院时间1—21d[（5．95±4．94）d]。结论TAPVC术后早期呼吸系统的并发症发生率最高，因此，防治肺部感染、维护肺功能应作为术后早期监测和处理的重点，同时注意纠正心律失常，防治低心排血量和肺动脉高压危象，以提高TAPVC患儿术后的成活率与监护质量。

Objective To summarize the early postoperation complications and treatments in children with total anomalous pulmonary venous connection （TAPVC）. Methods Thirty TAPVC children who were treated with corrective operation and transferred into PICU were collected. Patients were monitored routinely for electrocardiogram, blood pressure and SpO2. The routine treatment measures included mechanical ventilation, sedation, hemostasis, positive inotropic agents, diuresis, vasodilator, antibiotics and symptomatic treatment. Adrenaline or isoproterenol was used when low cardiac output syndrome appeared and temporary pacemaker was employed in the case of bradycardia. Alprostadil and sildenafil were added instantly after corrective operation when severe preoperative pulmonary hypertension or reactive postoperative pulmonary hy- pertension was present. Results The early postoperation complication was found in 30 cases of TAPVC, which included 13 cases of pneumonia （43.3%） ,8 of arrhythmia （26. 7% ） ,7 of low cardiac output syndrome （23.3%） ,6 of respiratory failure （20. 0% ） ,4 of pulmonary hypertension （ 13.3% ） ,3 of pulmonary edema or atelectasis（ 10. 0% ） and 1 of pneumorrhagia （3.3%）. Two cases died postoperatively. The interval of stay in PICU was 1 - 21 d and the mean time was （5.95 _＋ 4.94） d. Conclusion Occurrence of respiratory complications is high among early postoperative complications of TAPVC. Therefore, preventing pulmonary infection and maintaining pulmonary function should be viewed as the key points in early postoperative monitoring and managing. In addition, more attention should also be paid on correction of arrhythmia, prophylaxis and treatment of low cardiac output syndrome and pulmonary hypertension crisis, which may improve the postoperative survival rate and care quality of TAPVC.