心脏手术漏诊及术中体外循环处理

The Missed Diagnosis in Cardiovascular Surgery and Its Countermeasures

目的 了解心血管手术漏诊的原因 ,以及术中体外循环的处理对策 ,避免漏诊造成的影响。方法 11例患者被漏诊。术前诊断为室间隔缺损 6例 ,法乐四联症 3例 ,完全性肺静脉异位连接和二尖瓣狭窄各 1例。术中发现 2例法乐四联症、2例室间隔缺损和 1例完全性肺静脉异位连接合并有动脉导管未闭 ,1例法乐四联症、2例室间隔缺损合并有左上腔静脉 ,2例室间隔缺损和 1例二尖瓣狭窄合并有房间隔缺损。结果 把 5例合并动脉导管未闭患者的温度降低到鼻温 2 3.2℃± 1.7℃ ,肛温 2 1.7℃± 2 .3℃进行手术 ,未发现有术后并发症。结论 先天性心脏病病变非常复杂是造成漏诊的普遍原因 。

Objective To investigate the causes of the missed diagnosis in cardiovscular surgery and its countermeasures.Methods There were 11 missed diagnoses, among which 6 had been diagnosed as ventricular septal defect(VSD) ,3 as teralogy of fallot(TOF),1 as total anomalous pulmonary venous connection (TAPVC) and 1 as mitral stenosis (MS) before operation ,but during operations, 2 VSDs,2 TOFs and 1 TAPVC accompanied by PDA of VSD,1 TOF and 2 VSDs accompanied by left superior venous cava (LSVC),2 VSDs and 1 MS accompanied by atrial septal defect (ASD) were found.Results The temperatures of 5 patients who were accompanied by PDA were lowered to 21.7℃±2.3℃ in nasopharyngeal and 23.2℃±1.7℃ in anal, then operations were carried out.No complications were found in all patients.Conclusion The congenital heart diseases were very complicated, which usually led to the missed diagnosis. Quick adjustment of cardiopulmonary bypass methods according to the new diagnosis during operations should be very important to avoid serious complications after operations.