小儿复杂先天性心脏病姑息手术后的管理

The management of children with complex congenital heart disease after palliative surgery

目的:探讨小儿复杂性心脏病姑息手术的术后管理要点。方法:自2005年3月—2012年2月对23例复杂性先天性心脏病患儿施行姑息手术,其中双向腔肺分流术13例,改良体肺分流术6例,肺动脉环缩术4例,术后根据不同手术特点,采取积极循环支持,适当容量补充,平衡体肺血流及不同的机械通气策略等综合处理方法。结果:早期死亡3例,20例患儿顺利出院,死亡率13.0%。死亡原因分别为上腔静脉梗阻,心跳骤停及低心排综合征。术后随访6月~1年,除1例改良体肺分流术后患儿不明原因猝死外,其余无远期死亡,术后一般情况改善,氧饱和度分别为(90.2±2.17),(88.5±4.2),(83.9±3.1),心功能分级Ⅰ级2例,Ⅱ级16例,Ⅲ级1例,部分患儿行二期根治手术。结论:姑息手术是治疗小儿复杂先天性心脏病的有效治疗手段,术后根据不同的手术方法及病理生理特点,采用针对性的管理策略是减少术后并发症及降低死亡率的关键。

Objective To study the postoperative management of pediatric palliative operation complexity of heart disease.Methods From 2005.3 to 2012.2 a palliative surgery for 23 cases of children with complex congenital heart disease, including bidirectional cavity, including 13 cases of pulmonary bypass, improved pulmonary bypass, 6 cases, 4 cases were pulmonary annulus shrinkage method, according to characteristics of different surgery, postoperative take positive cycle, the appropriate volume replacement, balance the body of the pulmonary blood flow and different mechanical ventilation strategies such as comprehensive treatment method.Results 3 cases of early death, 20 cases discharged smoothly, the mortality rate of 13.0%.The cause of death of superior vena cava obstruction respectively, cardiac arrest and low cardiac syndrome.Postoperative follow-up of 6 months-1 year, except for 1 case improved body lung bypass surgery in children with unexplained sudden death, the rest die without long-term postoperative generally improved, oxygen saturation, respectively(90.2±2.17),(88.5±4.2),(83.9±3.1), cardiac function class Ⅰ in 2 cases, Ⅱ level 16 cases, Ⅲ level 1 case, part of the role of the second phase of radical surgery.Conclusion Palliative surgery is an effective therapy for treatment of children with complex congenital heart disease, according to the different surgical methods and postoperative pathological physiology characteristic, adopt corresponding management strategy is the key to reduce postoperative complications and reduce mortality.