摘要
目的 总结心胸外科监护室 (CICU)新生儿先天性心脏病 (先心病 )术后管理体会。方法 新生儿先心病术后 5 0例 ,术时年龄 2～ 30d ,平均 (15 2± 8 7)d ,≤ 15d者 2 4例 ;术时体重 2 3～ 4 5kg,平均(3 4± 0 5 )kg。病种包括大血管错位、肺动脉闭锁 /室隔完整、法洛四联症 /肺动脉闭锁等。其中施行根治术 76 % ,姑息术 2 4 %。术毕应用改良超滤 4 2例 ,心内置管 39例 ,延迟关胸 2 1例。呼吸机支持时间 2 1 5～910 0h。术后 4 8例应用正性肌力药物 ,包括氨力农、米力农等。结果 术后主要并发症包括低心输出量综合征 (低心排 ) 12例 ,低氧血症 10例 ,感染 5例。本组死亡 6例 ,死亡率为 12 % ,均为严重低心排者 (其中3例伴肾功能衰竭 )。结论 防治术后低心排是降低新生儿先心病术后病死率的关键 ,包括施行改良超滤、延迟关胸、预防性静脉应用米力农等措施。此外 ,加强基础护理、营养支持、预防感染、建立绿色通道亦很重要。
Objective: The aim of this study was to summarize the postoperative care skill of neonatal congenital heart disease in cardiac intensive care unit (CICU). Methods: Fifty patients were included in this study. Their mean age was (15 2±8 7) day, (2～ 30 days) and the mean body weight was (3 4±0 5) kg (2 3～4 5 kg). The diagnoses included transposition of the great arteries (52%), pulmonary atresia with intact ventricular septum (24%), and tetrology of Fallot with pulmonary atresia (4%). 76% of patients underwent corrective procedure and 24% of patients underwent palliative procedure. 84% of patients received modified ultrafiltration after cardiopulmonary bypass. 78% of patients had intracardiac line. 42% of patients underwent delayed sternal closure. The time on mechanical ventilation was 21 5 to 910 0 hours. 96% of patients were administered inotropic support, including Amrinone or Milrinone (72%). Results: The postoperative complications were low cardiac output syndrome (12 cases), developed hypoxemia (10 patients), and developed infection (5 patients). There were six hospital deaths with mortality rate of 12%. The main cause of death was severe low cardiac output and acute renal failure. Conclusion: The key of decreasing postoperative mortality rate is proper management of low cardiac output. The postoperative checklist include modified ultrafiltration, delayed sternal closure, prophylactic intravenous use of Milrinone, intensive basic nursing, nutritional support and the prevention of infection.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2003年第4期212-214,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
新生儿
先天性心脏病
术后
处理
并发症
手术后
监护
Heart defect, congenital Cardiac output, low Postoperative complications Custodial care
