摘要
目的：回顾总结１９９３年１月至１９９５年９月期间，我院小儿重症监护病房收治的３６０例３个月至５岁小儿法乐四联症围术期治疗的经验。方法：３６０例患儿平均年龄２．７６±１．４９岁（３个月至５岁），平均体重１１．４５±３．２５（５～２２）ｋｇ，平均血红蛋白１６６．６±３５．０（８４～２８６）ｇ／Ｌ。全组患儿均在全麻低温体外循环下行心内畸形一期根治手术。术后常规使用小剂量多巴胺及多巴酚丁胺维护心脏功能，合理调整晶体、胶体渗透压比例及入量。结果：本组共出现并发症３０例（８．３３％），死亡４例（１．１１％）。结论：本组患儿治疗效果满意，死亡率低，作者认为与下列因素密切相关：组织一组训练有素的专职小儿心外科、心内科、麻醉科、体外循环科医护人员，建立符合小儿不同年龄组的手术治疗常规是提高治疗效果的基本保证。术前积极纠治营养不良、贫血、控制感染，提高患儿对大手术的承受能力，可降低术后部分并发症的发生率；术后常规使用多巴胺或多巴酚丁胺维护心脏功能，重视纠正低钙血症（＜１１０ｎｍｏｌ／Ｌ）。严格根据测定的血浆胶体渗透压值［范围：２．２７～２．６７ｋＰａ（１７～２０ｍｍＨｇ）］、血红蛋白和血细胞比容结果输全血或血浆，早期控制出入量?
Objective:To sum up the perioperative management of 360 pediatric patients with tetralogy of Fallot operated between Jan.1993 and Oct.1995. Methods:The patients aged 2.27±1.49 years with body weight of 11.45±3.25 kg,average blood hemoglobin 16.6±35.0(8.4 28.6)g% were totally corrected under deep hypothermia and CPB,low dosages of dopamine and dobutamine were used to maintain better cardiac function after operation and the infusion volume as well as the ratio of crystal and colloid were adjusted reasonably. Results:There were 30 cases (8.33%) of postoperative complications and 4 cases of early death (1 11%). Conclusions:The decrease of mortality of this group is considered to be related to the following factors:①Organization of a group of trained doctors and nurses in cardiac surgery,cardiology,pediatrics,anesthesiology,and cardiopulmonary bypass,and set up of routine procedures suitable for children of different ages are fundamental guarantee of successful operation.②Adoption of rigorous measures to correct or treat preoperative poor nutrition,anaemia,and infection so as to enhance the acceptability to major operation and decrease postoperative complications.③Use of dopamine and dobutamine to uphold the cardiac function and correction of hypocalcemia(<110 mmol/L),control of blood infusion according to plasma colloidal pressure 2.27 2.67 kpa(17 20 mmHg),HB and HCT.In the early postoperative period,the discharge volume should be more than the infusion volume.④Evaluation of the early postoperatire cardiac function and correction of the anomalies in critical infants with bedside echocardiography and guide the management of low output syndrome.
出处
《中国循环杂志》
CSCD
1996年第8期464-467,共4页
Chinese Circulation Journal
关键词
法乐氏四联症
围术期
儿童
心脏外科手术
Pediatric tetralogy of Fallot
Perioperative management (Chinese Circulation Journal,1996,11:464.)
