中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2012年
1期
53-55
,共3页
完全性肺静脉异位引流%术后并发症%处理对策%儿童
完全性肺靜脈異位引流%術後併髮癥%處理對策%兒童
완전성폐정맥이위인류%술후병발증%처리대책%인동
Total anomalous pulmonary venous connection%Postoperation complication%Treatment strategy%Children
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l～21 d[(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.
目的 瞭解完全性肺靜脈異位引流(total anomalous pulmonary venous connection,TAPVC)術後早期髮生的併髮癥,總結處理對策.方法 收集行TAPVC根治術後轉入PICU鑑護的患兒30例,術後常規心電、血壓、血氧飽和度鑑護,呼吸機輔助呼吸,併經鎮靜、止血、正性肌力藥物治療、利尿、擴血管、抗感染及對癥等綜閤處理.有低心排血量錶現時再加用腎上腺素或異丙腎上腺素.齣現緩慢性心律失常時,予臨時起搏器治療.患兒術前即有重度肺動脈高壓或術後判斷有反應性肺動脈高壓時予前列地爾或西地那非.結果 30例患兒術後併髮肺炎13例(43.3％),心律失常8例(26.7％),低心排血量綜閤徵7例(23.3％),呼吸衰竭6例(20.0％),肺動脈高壓4例(13.3％),肺水腫及肺不張各3例(10.0％),肺齣血1例(3.3％).術後早期死亡2例.ICU住院時間l～21 d[(5.95±4.94)d].結論 TAPVC術後早期呼吸繫統的併髮癥髮生率最高,因此,防治肺部感染、維護肺功能應作為術後早期鑑測和處理的重點,同時註意糾正心律失常,防治低心排血量和肺動脈高壓危象,以提高TAPVC患兒術後的成活率與鑑護質量.
목적 료해완전성폐정맥이위인류(total anomalous pulmonary venous connection,TAPVC)술후조기발생적병발증,총결처리대책.방법 수집행TAPVC근치술후전입PICU감호적환인30례,술후상규심전、혈압、혈양포화도감호,호흡궤보조호흡,병경진정、지혈、정성기력약물치료、이뇨、확혈관、항감염급대증등종합처리.유저심배혈량표현시재가용신상선소혹이병신상선소.출현완만성심률실상시,여림시기박기치료.환인술전즉유중도폐동맥고압혹술후판단유반응성폐동맥고압시여전렬지이혹서지나비.결과 30례환인술후병발폐염13례(43.3％),심률실상8례(26.7％),저심배혈량종합정7례(23.3％),호흡쇠갈6례(20.0％),폐동맥고압4례(13.3％),폐수종급폐불장각3례(10.0％),폐출혈1례(3.3％).술후조기사망2례.ICU주원시간l～21 d[(5.95±4.94)d].결론 TAPVC술후조기호흡계통적병발증발생솔최고,인차,방치폐부감염、유호폐공능응작위술후조기감측화처리적중점,동시주의규정심률실상,방치저심배혈량화폐동맥고압위상,이제고TAPVC환인술후적성활솔여감호질량.
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 hypertension 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.
