跨区域、跨海拔远程输送及诊治先天性心脏病患儿:疗效及并发症观察研究

Diagnosis and treatment of congenital heart disease in children crossing over altitudes and regions through long-distance transportation:observational study of efficacy and complications

目的:本研究旨在评估跨地理区域、跨海拔气候远程输送及诊疗先天性心脏病患儿模式的可行性及安全性。方法:组建了一支专业团队,前往西藏对3个县区的2800名儿童进行经胸多普勒超声心动图检查,随后组织了跨越3000 km的远距离输送,对符合手术指征的患儿进行手术治疗。西藏当地社保和社会慈善机构共同提供诊疗经费支持,手术由上海、福建两地的专家共同主刀,术后观察相关不良事件,复查心电图、经胸超声心动图评估手术效果。结果:共筛选出19例先天性心脏病患儿,中位年龄6岁,男性患儿10例;包括房间隔缺损10例,动脉导管未闭4例,室间隔缺损4例,室间隔缺损合并动脉导管未闭1例;在整个远程和长时间的接送过程中,未发生任何患儿或家属的不良事件。6例房间隔缺损及4例动脉导管未闭患儿进行了介入封堵术治疗,4例房间隔缺损、4例室间隔缺损及1例室间隔缺损合并动脉导管未闭患儿进行了心外科开胸手术。所有患儿术后复查未见残余分流,术后左心室射血分数(LVEF)64.7%±7.1%,与术前LVEF(68.4%±4.6%)比较差异无统计学意义(P>0.05);术后肺动脉压力(28.3±8.3)mmHg,低于术前(37.7±13.4)mmHg(P<0.05)。进行介入治疗的患儿术后心电图PR间期为(130.3±16.3)ms,与术前(126.0±15.2)ms比较差异无统计学意义(P>0.05);术后QRS间期(77.4±7.7)ms与术前(81.6±10.3)ms比较差异无统计学意义(P>0.05)。1例动脉导管未闭患儿在手术后1~2 d出现了短暂的头痛、头晕、血压升高症状,但1周后完全康复。其他患儿在手术后恢复良好,2周后安全返回西藏。结论:由于地区发展差异,某些地区的医疗条件较为薄弱,无法满足当地儿童先心病的诊疗需求。通过将患儿远程输送至经济发展水平较高的地区进行治疗,取得了预期的手术有效性和安全性。

Objective:To evaluate the effectiveness and safety of long-distance transportation and diagnosis and treatment of congenital heart disease in children across geographical regions and altitudes.Methods:A professional team was set up and went to Xizang to examine 2800 children in three counties and districts with transthoracic Doppler echocardiography,and then organized long-distance transportation across 3000 km to perform surgical treatment for children who meet the surgical indications.Financial support was provided by the local social security and social charity organizations in Xizang for diagnosis and treatment.Cardiologist from Shanghai and Fujian jointly conducted the operation.After the operation,relevant adverse events were observed,and the operation results were evaluated by rechecking electrocardiogram and color Doppler echocardiography.Results:19 children with congenital heart disease were selected,with a median age of 6.There were ten male children,and including 10 cases of atrial septal defect,4 cases of patent ductus arteriosus,4 cases of ventricular septal defect,and 1 case of ventricular septal defect combined with patent ductus arteriosus.There were no adverse events involving the child or family members during the entire long-distance and long-term transportation process.6 cases of atrial septal defect and 4 cases of patent ductus arteriosus underwent interventional closure surgery.4 cases of atrial septal defect,4 cases of ventricular septal defect,and 1 case of ventricular septal defect combined with patent ductus arteriosus underwent cardiac surgery.All patients postoperative follow-up by echocardiography indicated no residual shunt.The postoperative left ventricular ejection fraction(LVEF)was 64.7%±7.1%,compared to the preoperative LVEF of 68.4%±4.6%,there was no significant difference(P>0.05).The postoperative pulmonary artery pressure was(28.3±8.3)mmHg,which was significantly lower than the preoperative pulmonary artery pressure of(37.7±13.4)mmHg(P<0.05).The postoperative PR interval of children undergoing interventional therapy was(130.3±16.3)ms,compared to the preoperative PR of(126.0±15.2)ms,there was no significant difference(P>0.05).There was no significant difference between the postoperative QRS interval of(77.4±7.7)ms and the preoperative QRS interval of(81.6±10.3)ms(P>0.05).A child with patent ductus arteriosus experienced brief symptoms of headache,dizziness,and elevated blood pressure 1-2 d after surgery but fully recovered one week later.Other children recovered well after surgery and returned to Xizang safely two weeks later.Conclusion:Due to regional development differences,the medical conditions in some areas are relatively weak and can t meet the diagnosis and treatment needs of local children with congenital heart disease.The expected surgical effectiveness and safety have been achieved by transporting the patients over a long distance to areas with higher levels of economic development for treatment.