摘要
本文报道法乐氏四联症根治术80例,1986年前30例的术后死亡率为16.6％,1986年起连续50例无死亡,两组的差异在于术后早期妥善处理:(1)术后低心排,按左房测压管压力高低补血或强心扩容处理,术中置心外膜起搏导线,随时起搏治疗心动过缓或传导阻滞等心律失常;(2)防治呼吸衰竭的发生,控制液量输入,小儿病例体外预充液中加入白蛋白,防止肺间质水肿,开放循环时右室充分排气减少肺内气栓,术后早期气管冲洗避免分泌物阻塞,及早气管切开行辅助呼吸;(3)严防肾功能衰竭,术后保证组织的氧供,避免口受体升压药的应用或同时配用扩容剂,监测尿量加强利尿;(生)重视肺动脉瓣的重建,术后早期利尿和多巴胺强心剂的应用,治疗右心衰竭等。
Eighty cases of tetralogy of Fallot undergoing total correction procedures were studied retrospectively. The mortality was 16.6% in the group of 30 patients before 1986 and there was no death in the group of 50 patients after 1986. The difference between these two groups was attributed mainly to the effective postoperative management: 1. Blood transfusion or pharmaceutic intervention was applied according to the monitored LAP to treat postoperative low cardiac output syndrome, and postoperative arrhythmias were managed by cardiac pacing placed on the epicardium during operation. 2. Respiratory failure was prevented and treated by limiting fluid intake, reducing pulmonary air embolism, early postoperative tracheal irrigation and early tracheotomy to re-establish ventilation. 3. Renal failure was prevented by ensuring organ oxygen supply, monitoring urine output or administration of diuretic and avoiding the use of vasoconstrictor. 4. Reconstruction of pulmonary valve, early postoperative diuresis and use of dopamin to diminish occurrence of right ventricular failure.
出处
《上海医学》
CAS
CSCD
北大核心
1990年第5期249-253,共5页
Shanghai Medical Journal
