摘要
目的：回顾总结１９４例体重１０ｋｇ以下婴幼儿先天性心脏病围术期处理经验，探讨适合低体重婴幼儿特点的围术期处理常规。方法：患儿年龄３～３６个月，平均１４．７±１０．８个月；体重３．０～９．５ｋｇ，平均７．７±２．３ｋｇ。围术期处理主要采取以下措施：①术前完善各项检查，积极治疗肺炎、心力衰竭、贫血等并发症。②术后早期根据患儿肺部病变情况，动态地调整呼吸机参数，不主张长时间应用大潮气量、大呼气末正压的通气方式，适时选择拔管时机。③合理调整术后容量，避免短时间内输入大量库血，早期适量应用正性肌力药物改善心功能，对紫绀型小婴儿重视纠正低钙血症。结果：１９４例患儿中３０例（１５．４６％）出现术后并发症，死亡８例（４．１２％），主要原因为心跳骤停、肺动脉高压及多器官衰竭。结论：探讨并建立适合体重１０ｋｇ以下婴幼儿特点的围术期处理常规，这有助于降低术后并发症，减少死亡率。
Objective:To sum up the perioperative management of 194 pediatric patients less than 10kg with congenital heart defects and go further into the routine methods of perioperative management that is suitable for low body weight infants. Methods:The patients aged 14 7±10 8 months with body weight of 7 7±2 3 kg.The perioperative measures were as follows:1. To perform all the examinations before operation and adopt the rigorous measures to correct preoperative pneumonia,heart failure and anaemia.2.In the early postoperative period,to adjust the respirator parameters according to patient′s pulmonary function.Large tidal volume and high PEEP were not allowed for a long time.To choose extubation opportunity at the right moment.3.To adjust postoperative blood volume reasonably and avoid a large amount of blood infusion in a short time.An appropriate dosage of positive inotropic drugs was used to improve cardiac function.The postoperative hypocalcemia was corrected in cyanotic infants. Results:There were 30 cases(15 46%)of postoperative complications and 8 cases of early death(4 12%) mainly due to cardiac arrest,pulmonary hypertension and multiple organ failure. Conclusion:The established routines of perioperative management suited for pediatric patients with body weight less than 10kg contributes to the decreases of postoperative complications and mortality rate.
出处
《中国循环杂志》
CSCD
北大核心
1997年第2期97-100,共4页
Chinese Circulation Journal
