Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.
目的 探讨≤10 kg体重婴幼儿心脏直视术后呼吸机使用时间的相关因素。 方法 从2005年3月－2011年6月，选择纳入接受心脏直视手术的体重≤10 kg的先天性心脏病婴幼儿，分析各项围术期指标与术后呼吸机使用时间的关系，讨论该类婴幼儿术后呼吸机使用时间决策。 结果 共纳入体重≤10 kg的婴幼儿42例，呼吸机使用时间（42.74 ± 52.55） h，中位数20.88 h;发现术后2 h入量（mL/kg），术后4、8、16 h总入量（mL/kg）与术后呼吸机使用时间相关（P＜0.05），术后呼吸机使用时间与患儿ICU入住时间约成线性相关（P＜0.05）。 结论 影响低体重婴幼儿心脏直视术后呼吸机使用时间是术后液体管理，实施“限制性液体管理”治疗策略可能会促进患儿的术后快速康复。术后液体管理如何具体影响患儿呼吸机使用时间，影响患儿的预后，尚需进一步研究。Objective To evaluate the factors related to the postoperative mechanical ventilation (MV) duration in low-weight infants weighing less than 10 kg having undergone open cardiac surgery. Methods From March 2005 to June 2011, infants less than 10 kg undergoing congenital cardiac surgery were included in this research. We analyzed the relationship between various peri-operative indexes and the duration of MV, and discussed the decision for ventilation time for these infant patients. Results A total of 42 infants were included in our study. The ventilation time was (42.74 ±52.55) hours with a median of 20.88 hours. The postoperative second-hour fluid intake and the total intake of fluid at hour 4, 8, and 16 were related to the duration of mechanical ventilation (P＜0.05). And the ventilation time had a linear relationship with the ICU-stay time (P＜0.05). Conclusions The postoperative fluid management is associated with the duration of mechanical ventilation for low-weight infants having undergone open cardiac surgery. “Fluid controlling management” may facilitate quick recovery of the infant patients. However, as for how the fluid should be managed, how the fluid management influences ventilation time and the prognosis, more research is needed.
【摘要】 目的 总结先天性心脏病术后无创通气的监护。 方法 2008年1-12月胸外ICU 36例先天性心脏病术后患儿，在使用无创通气前后监测血压、心率、呼吸及血气变化。 结果 与无创通气前相比，无创通气后30 min、1 h、2 h的指标均恢复到满意水平，循环稳定。 结论 通过采用无创通气，80%的患儿避免了再次插管，缩短有创通气时间，同时避免了相关的呼吸道并发症，缩短了患儿住院时间，节省了医疗费用，提升了先天性心脏病患儿术后成活率。【Abstract】 Objective To summarize the nursing experience of noninvasive ventilation for infants with congenital heart disease after the surgery. Methods A total of 36 patients who underwent noninvasive ventilation from January to December 2008 were enrolled. The blood pressure, heart rate, respiration, and blood gas were recorded and analyzed before and after noninvasive ventilation. Results Compared with the results before noninvasive ventilation, all of the indexes returned to a satisfying level and the circulation kept stable 30 minutes, one hour, and two hours after noninvasive ventilation. Conclusion Noninvasive ventilation may avoid reintubation, shorten the invasive ventilatory time, decrease the respiratory complications, shorten the time of hospitalization, save the medical expenses, and promote the survival rate of infants with congenital heart disease.
目的：探讨彩色多普勒超声在心脏手术中的应用价值。方法：在14例心脏病手术中，于心脏修复完成后经心外膜超声检查。结果：一例先天性心脏病室间隔缺损修补片周少量残余漏；一例风湿性心脏病二尖瓣、主动脉瓣置换术后，主动脉瓣下少量返流；因不构成血流动力学的改变，未行二次修复。结论：可即时、准确地为外科医生提供相关信息，评价手术效果。
Objective To explore the efficacy of humidified high flow nasal cannula ( HHFNC) for respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease. Methods FromJanuary 2010 to August 2010, 33 newborns and infants [ ( 7. 8 ±8. 4) months, range 3 days to 36 months; weight ( 6. 6 ±3. 6) kg, range 2. 2 to 19. 6 kg] were treated with HHFNC ( 22 cases) and routine oxygen therapy ( 11 cases) for respiratory failure following ventilator weaning after operation of congenital heart disease. Symptoms, blood oxygen saturation ( SpO2 ) , partial pressure of oxygen( PaO2 ) , partial pressure of carbondioxide ( PaCO2 ) , incidence rate of re-intubation, duration of ICU, and hospital stay were assessed and compared between the HHFNC group and the routine oxygen therapy group.Results There were no statistical significance in the duration of ICU, hospital stay, duration of mechanical ventilation, or infection rate between the HHFNC group and the routine oxygen therapy group ( P gt; 0. 05) . But the incidence rate of re-intubation was lower in the HHFNC group than that in the routine oxygen therapy group. Meanwhile SpO2 and PaO2 increased and PaCO2 decreased significantly in the HHFNC group ( P lt;0. 05) . Conclusion HHFNC shows a clinical improvement rapidly and efficiently in preventing respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease.
Objective To observe early and intermediate-term clinical outcomes of tricuspid valvuloplasty withannuloplasty ring for the treatment of secondary tricuspid regurgitation （TR） of patients with rheumatic heart disease. MethodsFrom December 2009 to September 2011, 41 patients with rheumatic heart disease underwent left-side heart valve replacementand concomitant tricuspid valvuloplasty with annuloplasty ring in Sichuan Jianyang People’s Hospital. There were 12 males and 29 females with their mean age of 49 （21-67） years. Preoperatively, there were 38 patients with atrial fibrillation, 13 patients with left atrial thrombus; 2 patients with trivial TR, 5 patients with mild TR, 11 patients with moderate TR, and 23 patients with severe TR. Twenty-eight patients received mitral valve replacement and 13 patients received mitral and aortic valve replacement. All the patients were followed up every 3 months at the outpatient department, and received color Doppler echocardiography examination to observe TR degree at the 6th postoperative month. Results Postoperative heart function improved by 2-3 class in all the patients. There were 39 patients with New York Heart Association (NYHA) classⅠorⅡ postoperatively, and postoperative heart function was significantly better than preoperative heart function（P＜0.05）. All the patients were followed up for 6-27 months, and there was no death during follow-up. Color Doppler echocardiography at the 6th postoperative month showed that TR degrees were significantly decreased than preoperative TR degrees. There were 39 patients with trivial or mild TR during follow-up, which was significantly different with preoperativeTR degree （P＜0.05）. Right ventricle dimension decreased from preoperative 20 mm to 17 mm during follow-up, which were statistically different （P＜0.05）. Conclusion Early and intermediate-term clinical outcomes of tricuspid valvuloplasty with annuloplasty ring for the treatment of TR are satisfactory, while further evaluation for its long-term outcome is needed.