Congenital Heart Disease Referred for Surgery: Analysis and Epidemiological Description in the Cardiology Department of CHU Ignace Deen

Introduction: Congenital heart disease includes all cardiac and vascular malformations. It accounts for approximately one third of all congenital malformations and is a public health problem, particularly in developing countries. The aim of this study was to analyze the epidemiological, clinical and paraclinical aspects of congenital heart disease. Methods: This was a retrospective descriptive and analytical study based on the records of 135 patients referred for surgery and followed up in the cardiology department of the Ignace Deen University Hospital, collected in November 2022. Results: Hospital prevalence was 5%. The mean age was 71 months, ranging from 1 month to 19 years. The age group over 24 months was the most represented (62%). The M/F sex ratio was 1.36. Urban origin was predominant (58%). The rate of children not attending school or dropping out was high (16%). Siblings with fewer than 4 children were the most common (88%). A heart murmur was the most frequent sign (78%), followed by cyanosis (36%) and heart failure (29%). The association between heart murmurs and CHD was proven with a p-value Conclusion: CHDs represent the main indication for paediatric cardiac surgery and follow-up (95%). We stress the importance of implementing a screening and management strategy for congenital heart disease.

A New Three-Dimensional(3D)Printing Prepress Algorithm for Simulation of Planned Surgery for Congenital Heart Disease

Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac surgery will allow us to study features of the anatomy and spatial relations of a defect and to simulate the optimal surgical repair on a printed model in every individual case.Methods:We performed the prospective cohort study which included 29 children with congenital heart defects.The hearts and the great vessels were modeled and printed out.Measurements of the same cardiac areas were taken in the same planes and points at multislice computed tomography images(group 1)and on printed 3D models of the hearts(group 2).Pre-printing treatment of the multislice computed tomography data and 3D model preparation were performed according to a newly developed algorithm.Results:The measurements taken on the 3D-printed cardiac models and the tomographic images did not differ significantly,which allowed us to conclude that the models were highly accurate and informative.The new algorithm greatly simplifies and speeds up the preparation of a 3D model for printing,while maintaining high accuracy and level of detail.Conclusions:The 3D-printed models provide an accurate preoperative assessment of the anatomy of a defect in each case.The new algorithm has several important advantages over other available programs.They enable the development of customized preliminary plans for surgical repair of each specific complex congenital heart disease,predict possible issues,determine the optimal surgical tactics,and significantly improve surgical outcomes.

Management of Specific Complications after Congenital Heart Surgery(I)

In addition to the general consequences of surgery and cardiopulmonary by-pass, lesion-specific complications can occur after surgery for congenital heart disease. It is important for the pediatric intensive care specialist to fully understand the preoperative anatomy and the intraoperative details of these patients. This allows a timely and appropriate treatment of general and lesion-specific complications. In this article we provide a list of commonly-performed surgical procedures and possible associated problems to be anticipated in the early postoperative period. Then it follows a discussion about the diagnosis and management of these complications, based on their pathophysiological features.

Evaluation of Post-Operative Atrial Fibrillation after Cardiac Surgery for Adult Congenital Heart Disease

Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.

Unmet Needs in Pediatric and Congenital Heart Surgery:A Review

Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart disease(RHD)yearly.Although the vast majority of children born with CHD in high-income countries now reach adulthood and RHD is nearly eradicated in these countries,most of the world cannot access the necessary care to prevent or mitigate PCHD.In low-and middle-income countries,over 90%of children with PCHD cannot receive the care they need,as over 100 countries and territories lack local cardiac surgical capacity.The unmet needs for PCHD are large,albeit still poorly quantified,resulting in a considerable socioeconomic impact at the individual and societal levels.This review highlights the extensive opportunities to improve access to and scale PCHD care by strengthening research,clinical care delivery,capacity-building,advocacy,health policy,and financing.We discuss global disparities in access to congenital heart surgery,the socioeconomic impact of untreated PCHD,and propose strategies for scaling pediatric and congenital cardiac care.Our recommendations focus on enhancing research and data collection,expanding training programs,improving healthcare infrastructure,advocating for policy changes,leveraging technological innovations,fostering international collaborations,and developing comprehensive care models.

Comparison of clinical outcomes and postoperative recovery between two open heart surgeries:minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy

Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.

Prediction of Pulmonary Arterial Pressure Level after Repair of Congenital Cardiac Communications and Discharge from the Hospital: Role of Down Syndrome and Early Postoperative Hemodynamics

Background:Postoperative pulmonary hypertension limits the success of surgical treatment in some patients with unrestrictive congenital cardiac communications.Identifying patients at risk of developing postoperative pulmonary hypertension is important to individualize follow-up strategies.Methods:We analyzed a prospective cohort of 52 pediatric patients(age 3 to 35 months)looking for perioperative predictors of mildly elevated pulmonary arterial pressure 6 months after surgery,defined as a systolic pressure greater than 30 mmHg by transthoracic echocardiography.This corresponds to a mean pulmonary arterial pressure of>20 mmHg.Clinical,echocardiographic and hemodynamic parameters were investigated.Perioperative hemodynamics was assessed by directly measuring pulmonary and systemic arterial pressures using indwelling catheters.Early postoperative pulmonary hemodynamics was defined as the mean pulmonary/systemic mean arterial pressure ratio(PAP/SAP)obtained per patient during the first 6 h of postoperative care.Results:Among the factors that were investigated as possible predictors,perioperative hemodynamics and the presence of Down syndrome were initially selected using univariate analysis(p<0.030).Early postoperative PAP/SAP was correlated with PAP/SAP obtained in the operating room just after cardiopulmonary bypass(r=0.70,p<0.001),and it was higher in subjects with Down syndrome than in nonsyndromic individuals(p=0.003).Early postoperative PAP/SAP was the only predictor selected using multivariate analysis.It was characterized as an independent predictor after adjustments for possible confounders.An early postoperative PAP/SAP of>0.35 was 76%sensitive and 74%specific at predicting a systolic pulmonary arterial pressure of>30 mmHg 6 months after surgery(hazard ratio with 95%CI 8.972[2.428–33.158],p=0.002).Conclusion:The hypertensive early postoperative behavior of the pulmonary circulation was strongly but not exclusively associated with Down syndrome,and it was characterized as an independent predictor of altered pulmonary arterial pressure after discharge from the hospital.

Coronary Artery Complications after Right Ventricular Outflow Tract Reconstruction Surgery

Background:Mechanisms and clinical manifestations of coronary artery complications after right ventricular outflow tract reconstruction surgery are not well known.Methods:Patients who had coronary artery complications after pulmonary valve replacement or the Rastelli procedure at a single tertiary centre were retrospectively analysed.Results:Coronary artery complications were identified in 20 patients who underwent right ventricular outflow tract reconstruction surgery.The median age at diagnosis of coronary artery complication was 21 years(interquartile range:13–25 years).Mechanisms of coronary artery complications were compression by adjacent materials in 12 patients,dynamic compression of intramural course of coronary artery in two patients,and intraoperative injury in six patients.Congenital coronary artery anomalies were identified in 50%(10/20)of patients.Four patients presented with early postoperative haemodynamic instability.Fourteen patients showed late onset symptoms or signs of coronary insufficiency,including chest pain,ventricular dysfunction,or ventricular arrhythmias.Coronary artery stenosis was incidentally found on cardiac computed tomography angiography in two asymptomatic patients.Four patients underwent surgical interventions,and one patient underwent percutaneous coronary intervention for coronary stenosis.One patient with recurrent ventricular tachycardia required an implantable cardioverter-defibrillator.There were two deaths in patients with intraoperative coronary injury.Conclusion:Preoperative coronary evaluation and long-term follow-up for the development of coronary artery complications are required in patients undergoing right ventricular outflow tract reconstruction surgery to prevent ventricular dysfunction,arrhythmias,and death,especially among those with congenital coronary anomalies.

SURGICAL EXPERIENCE OF COMPLEX CONGENITAIL HEART DEFECTS IN CHILDREN AND INFANTS

From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.

Blood conservation pediatric cardiac surgery in all ages and complexity levels

AIM To demonstrate the feasibility of blood conservation methods and practice across all ages and risk categories in congenital cardiac surgery.METHODS We retrospectively analyzed a collected database of 356 patients who underwent cardiac surgery using cardiopulmonary bypass(CPB) from 2010-2015. The patients were grouped into blood conservation(n = 138) and nonconservation(n = 218) groups and sub-grouped based on their ages and procedural complexity scores. RESULTS There were no statistical differences in gender,weight,pre-operative and pre-CPB hematocrit levels in both groups. Despite equivalent hematocrit levels during and after CPB for both groups,there was significantly less operative homologous blood utilized in blood conservation group across all ages and complexity levels. CONCLUSION Blood conservation surgery can be performed in con-genital patients needing cardiac surgery in all age groups and complexity categories. The above findings in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products justify blood conservation in congenital cardiac surgery.

Cardiovascular surgery in Turner syndrome-early outcome and long-term follow-up

BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical comorbidities than can complicate the care of this patient population.AIM To describe the cardiovascular surgical outcomes of patients with TS.METHODS A retrospective case series was compiled of 51 consecutive TS patients who had at least one cardiovascular surgery at Mayo Clinic Rochester from 1977-2017.The baseline clinical data of these patients were reviewed including demographics,medical comorbidities,congenital heart disease history,and medications.Echocardiographic reports were analyzed in detail.Operative reports and surgical hospital courses were reviewed.Long-term mortality was determined using medical records and the Social Security Death Index.Survival analysis was performed with the Kaplan Meier method.RESULTS The cohort comprised 51 TS patients,average age at the time of surgery at Mayo Clinic was 28(8-41)years,and 23(45%)patients were under the age of 18.At the time of first Mayo Clinic surgery,18(35%)patients had previously undergone cardiac surgery at another institution.The most common procedures were repair of aortic coarctation in 14(28%)patients,aortic valve replacement in 6(12%)patients,and composite aortic root/ascending aorta replacement in 7(14%)patients,with 7 patients undergoing repair of more than one lesion.Aortic dissection required operative intervention in 5 patients.After initial Mayo Clinic surgery,subsequent operations were required in 6(13%)patients.Average hospital length of stay was 6±2 d.There were 4(8%)early surgical deaths.Freedom from death was 97%and 89%at 10 and 20 years,and the freedom from reoperation was 93%and 81%at 10 and 20 years.CONCLUSION Cardiovascular surgery is associated with 8%early mortality given the medical complexity of TS patients.Those who survive to dismissal have good survival.Later cardiovascular reoperations are not rare.

Population health and sociodemographic variables as predictors of access to cardiac medicine and surgery in Haiti

Background In Haiti,cardiovascular disease is a leading cause of morbidity and mortality,with congenital and rheumatic heart disease comprising a large portion of disease burden.However,domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood.We analyzed population-level sociodemographic variables to predict cardiac care outcomes across the 10 Haitian administrative departments.Methods This cross-sectional study combined data from a 2016-17 Haitian national survey with aggregate outcomes from the Haiti Cardiac Alliance(HCA)database(n=1817 patients).Using univariate and multivariable regression analyses,the proportion of HCA patients belonging to each of three clinical categories(active treatment,lost to follow-up,deceased preoperatively)was modeled in relation to six population-level variables selected from national survey data at the level of the administrative department.Results In univariate analysis,higher department rates of childhood growth retardation were associated with a lower proportion of patients in active care(OR=0.979[0.969,0.989],p=0.002)and a higher proportion of patients lost to follow-up(OR=1.016[1.006,1.026],p=0.009).In multivariable analysis,the proportion of department patients in active care was inversely associated with qualified prenatal care(OR=0.980[0.971,0.989],p=0.005),and child growth retardation(OR=0.977[0.972,0.983]),p=0.00019).Similar multivariable results were obtained for department rates of loss to follow-up(child growth retardation:OR=1.018[1.011,1.025],p=0.002;time to nearest healthcare facility in an emergency:OR=1.004[1.000,1.008,p=0.065)and for preoperative mortality(prenatal care:OR=0.989[0.981,0.997],p=0.037;economic index:OR=0.996[0.995,0.998],p=0.007;time to nearest healthcare facility in an emergency:OR=0.992[0.988,0.996],p=0.0046).Conclusions Population-level survey data on multiple variables predicted domestic disparities in HCA clinical outcomes by region.These findings may help to identify underserved areas in Haiti,where increased cardiac care resources are required to improve health equity.This approach to analyzing clinical outcomes through the lens of population-level survey data may inform future health policies and interventions designed to increase cardiac care access in Haiti and other low-income countries.

急诊介入治疗在肺血减少型复杂先天性心脏病外科术后的应用

目的:探讨急诊介入治疗在复杂先天性心脏病术后的应用经验。方法:收集我中心2013年1月至2023年5月,复杂先天性心脏病外科术后行急诊介入治疗的病例,分析基线资料、侧枝封堵前后的临床特点,外科术后侧枝分布、处理及临床转归。结果:共有12例肺血减少型复杂先天性心脏病术后因体肺侧枝行急诊介入治疗,其中男8例(66.7%)、女4例(33.3%);外科矫治手术中位年龄48(7.5, 93.0)个月,体质量13(6.9, 31.1)kg。其中10例术前行造影检查,有6例于外科术前行体肺侧枝封堵术,4例未见明显体肺侧枝或因体肺侧枝细小未封堵。所有患儿均行外科矫治术。7例患儿在外科术中有回血增多现象,2例在术中行体肺侧枝结扎。所有患儿因术后至少出现下述表现之一:不同程度的肺出血、血痰;需较高条件的呼吸机支持,呼吸末气道压高;影像学改变(胸X线片提示肺血多、肺部渗出或斑片影);无法拔除气管插管或拔管后不耐受;可伴有心功能不全及血氧饱和度维持不佳。所有患儿于外科矫治术后平均4.5(3.0,13.0)d行急诊体肺侧枝介入封堵术,共封堵体肺侧枝29支,平均每例患儿封堵侧枝2.4支。体肺侧枝主要源于胸主动脉(8例,66.7%)、头臂干动脉(8例,66.7%)及腹主动脉(2例,16.7%)。10患儿侧枝封堵术后病情改善:侧枝封堵后(55.8±30.4)h脱离呼吸机;且循环趋于平稳,心功能好转,顺利出院。另外2例因同时合并其他复杂情况,预后不良。结论:复杂多变的体肺侧枝循环是肺血减少型复杂先天性心脏病患儿的诊治难点之一,除了术前、术中早发现早干预,术后积极有效的急诊体肺侧枝封堵可作为补救措施,降低围术期并发症并改善围术期预后。

小儿先天性心脏病术后肺部感染转归相关因素的前瞻性队列研究

目的评估小儿先天性心脏病(CHD)术后肺部感染转归情况,并探讨分析转归失败的相关因素。方法选取2022年1月—2023年12月新疆医科大学第一附属医院小儿心胸外科收治的CHD术后肺部感染患儿173例为研究对象,根据入院28 d的预后情况将患儿分为预后不良组61例和预后良好组112例。多因素Logistic回归分析CHD术后肺部感染患儿预后不良的影响因素;采用R软件构建CHD术后肺部感染患儿预后不良的列线图预测模型;受试者工作特征(ROC)曲线评估列线图模型预测CHD术后肺部感染患儿预后不良的区分度,校准曲线评估模型的一致性。结果预后不良组患儿免疫力缺陷、机械通气时间≥48 h、纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级、左心室射血分数(LVEF)≤40%、WBC>12×109/L、NEU>70%、降钙素原(PCT)>0.5μg/L、白蛋白(Alb)≤35 g/L的比例均大于预后良好组(χ^(2)/P=7.273/<0.001、15.949/<0.001、9.414/0.002、10.473/0.001、29.572/<0.001、21.811/<0.001、10.154/0.001、11.864/0.001);多因素Logistic回归分析结果显示,免疫力缺陷、机械通气时间≥48 h、NYHA心功能分级Ⅲ~Ⅳ级、LVEF≤40%、WBC>12×10^(9)/L、NEU>70%、Alb≤35 g/L、PCT>0.5μg/L是CHD术后肺部感染患儿预后不良的独立危险因素[OR(95%CI)=7.381(2.513~21.677)、5.295(1.801~15.568)、8.928(3.030~26.300)、5.563(1.962~15.774)、3.108(1.590~6.076)、2.058(1.429~2.963)、3.415(1.211~9.626)、5.269(1.799~15.429)],并构建列线图模型;验证结果显示,ROC曲线下面积(AUC)为0.969(95%CI 0.945~0.992),模型预测CHD术后肺部感染患儿发生预后不良风险与实际风险的一致性良好(χ^(2)=7.086,P=0.681)。结论免疫力、机械通气时间、NYHA心功能分级、LVEF、WBC、NEU、Alb、PCT为影响CHD术后肺部感染患儿发生预后不良的独立危险因素,以此构建的列线图模型区分度与一致性均良好。

简单型先心病围术期中西医结合加速康复临床护理路径的构建及应用效果评价

目的构建简单型先心病围术期中西医结合加速康复外科(CMERAS)临床护理路径(CNP)并应用,探讨其对患儿术后康复的影响。方法选取2021年1月-2022年12月在我院行体外循环手术的90例简单型先心病患儿作为研究对象,采用随机数字表法分为对照组和观察组,每组45例。对照组实施小儿心脏外科常规护理;观察组严格按照构建的简单型先心病围术期CMERAS CNP实施护理。比较2组患儿术后康复情况、并发症发生率及护理满意度。结果观察组患儿的机械通气时间、尿管及引流管留置时间、首次下床活动时间、ICU治疗时间及住院天数明显短于/早于对照组(P<0.05);观察组患儿术后并发症总发生率明显低于对照组,差异有统计学意义(P<0.05);观察组满意度明显提高(P<0.05)。结论CMERAS CNP应用于简单型先心病围术期,可规范加速康复外科的护理行为,促进患儿早日康复,改善患儿结局,提高满意度,社会效益好,值得在临床上推广应用。

血栓弹力图在婴幼儿心脏手术中的临床应用与研究进展

血栓弹力图(TEG)已被推荐用于指导成人心脏手术围术期血液制品使用,其在婴幼儿复杂先天性心脏病手术中的应用及临床研究还十分有限。通过回顾近年相关临床研究,介绍TEG的基本概念、监测指标及临床意义,并对TEG在婴幼儿心脏手术中的应用及研究进展进行综述,为其进一步的临床实施提供指导依据。

右腋下小切口与胸骨正中切口两种入路方式治疗先天性心脏病患儿的效果观察

目的探讨先天性心脏病患者采取不同入路手术治疗的临床价值。方法抽取洛阳市中心医院2021年1月至2023年12月收入的先天性心脏病患儿70例,依据不同手术方式分为对照组与观察组,各35例,对照组接受胸骨正中切口,观察组接受右腋下小切口,对两组患儿临床指标(手术时间、体外循环时间、输血量、胸腔引流量、主动脉阻断时间、住院时间),疼痛程度,呼吸功能及并发症发生情况进行组间比较。结果两组患儿手术时间、体外循环时间、主动脉阻断时间相比,差异无统计学意义(P>0.05),观察组输血量、胸腔引流量均低于对照组,且住院时间短于对照组,差异有统计学意义(P<0.05);两组患儿各时间段呼吸功能指标相比,差异无统计学意义(P>0.05);观察组患儿各时间段疼痛程度评分均低于对照组,差异有统计学意义(P<0.05);两组患儿并发症发生风险相比,差异无统计学意义(P>0.05)。结论两种手术入路方式均可治疗先天性心脏病,且与胸骨正中切口相比,右腋下小切口不会影响患儿呼吸功能,且可改善疼痛程度,促进患儿快速康复,安全性较高,值得临床应用。

婴儿心脏术后肌钙蛋白T水平对机械通气时间延长的影响

目的探讨肌钙蛋白T对婴儿心脏术后机械通气时间延长的影响。方法回顾性选取2019年1月至4月在南方医科大学附属广东省人民医院心外科行体外循环下心内直视术的192例先天性心脏病婴儿,按术后即刻肌钙蛋白T水平分为肌钙蛋白T高值组(3798.0~10000.0 ng/L)、中值组(1827.0~3709.0 ng/L)和低值组(316.2~1801.0 ng/L),各64例。低值组中,女28例,男36例,日龄203.00(129.75,274.50)d;中值组中,女30例,男34例,日龄118.00(76.50,173.75)d;高值组中,女24例,男40例,日龄168.50(78.00,219.25)d。采用方差分析、秩和检验、χ^(2)检验进行统计分析,通过单因素和多因素logistic回归模型分析术后肌钙蛋白T水平与术后机械通气时间延长的相关性,通过单因素和多因素线性回归模型分析术后肌钙蛋白T水平与重症监护停留时间及术后住院天数的相关性。结果术前日龄越小、手术体外循环时间越长、主动脉阻断时间越长,术后肌钙蛋白T水平越高(均P<0.05)。在校正了性别、日龄、胎龄、术前血红蛋白、术前血清肌酐、体外循环时间、主动脉阻断时间、先天性心脏病手术风险调整评分(RACHS-1)等因素后,多因素回归模型发现,肌钙蛋白T水平升高是机械通气时间延长的独立危险因素[OR=1.2(1.1,1.3),P<0.001]。结论肌钙蛋白T水平升高与婴儿先天性心脏病术后机械通气时间延长有关。

家庭赋权方案对复杂先天性心脏病姑息术后患儿主要照顾者照顾能力的影响

目的:探讨家庭赋权方案对复杂先天性心脏病(CCHD)姑息术后患儿主要照顾者照顾能力的影响。方法:选取2022年6月1日~2024年4月1日首次接受CCHD姑息术后患儿主要照顾者60名,采取方便抽样法,将照顾者分为观察组和对照组各30名,对照组实施常规护理健康指导,观察组在常规健康指导基础上实施家庭赋权方案干预;比较两组主要照顾者照顾能力[采用照顾能力测量表(FCTI)]和照顾准备度。结果:出院时,两组FCTI评分和照顾准备度评分均高于入院时(P<0.05),且观察组高于对照组(P<0.01)。结论:对CCHD姑息术后的患儿主要照顾者实施家庭赋权方案,能有效提高照顾者的照顾准备度和照顾能力,帮助患儿家庭建立科学、有效的照顾方案,促进CCHD姑息术后患儿康复。

微创右侧腋下小切口手术治疗简单先天性心脏病的疗效及安全性

目的:探究微创右侧腋下小切口手术治疗简单先天性心脏病的疗效及安全性。方法:选取2019年1月1日至2022年10月1日于泰达国际心血管病医院行间隔类缺损修补术患儿250例,分为右腋下小切口组(研究组)125例及胸骨正中切口组(对照组)125例。比较2组手术相关指标[体外循环时间、主动脉阻断时间、手术时间、术后引流量、呼吸机使用时间、重症监护病房(ICU)停留时间]、应激指标[皮质醇、促肾上腺皮质激素(ACTH)]、神经损伤标志物[神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)]、炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、C反应蛋白(CRP)]、临床疗效及并发症(胸口畸形、切口感染、纵隔感染)发生率。结果:研究组体外循环时间、主动脉阻断时间、呼吸机使用时间、ICU停留时间均短于对照组,并发症发生率低于对照组,治疗有效率高于对照组(P均<0.05)。2组术后1 d皮质醇、ACTH、NSE、S100β、TNF-α、IL-6、CRP水平均上升,且对照组皮质醇、ACTH、NSE、S100β、TNF-α、IL-6、CRP水平显著高于研究组(P均<0.05)。结论:微创右侧腋下小切口手术可能通过改善简单先天性心脏病患儿机体应激及炎症反应状态,减轻脑损伤,降低并发症发生风险。