先天性心脏病术后心律失常的研究进展

心律失常是先天性心脏病术后常见并发症之一 ,术后短期的心律失常多与心肌收缩功能障得、心内膜下缺血、代谢失衡、中枢神经系统损伤、传导系统局部损伤或心内膜炎有关 ,而疤痕、心脏肥厚扩大和残留血流动力学影响则是导致术后慢性心律失常的主要原因。一旦出现心律失常 ,存在残留血流动力学异常者症状往往更明显 ,而频发心律失常及抗心律失常药物的应用将进一步损害心肌功能 ,影响患儿生存年限和生活质量。一、快速型心律失常1.房性心律失常 :房性心律失常多见于完全性大血管错位Mustard、Senning术后及Fontan术后 ,亦可见于房室瓣置换术…     

先天性心脏病术后心律失常诊治经验

目的　探讨先天性心脏病术后心律失常的诊断与治疗。方法　对 1 37例先天性心脏病术后心律失常的发生率、发病因素、治疗与转归进行总结分析。结果　 1 37例先天性心脏病患儿均经体外循环下直视心脏手术 ,手术后有 5 6例发生 89例次心律失常 ,发生率 4 0 9% ,其中激动起源异常 31例次 ,以室上性心律失常多见 ,各型传导阻滞 5 8例次 ,以完全性右束支传导阻滞最多。结论　病因除手术因素外 ,以心功能不全、洋地黄中毒和电解质紊乱为主。除室内传导阻滞随访后未见恢复外 ,其他病例通过病因或抗心律失常治疗多数痊愈 ,有效率分别为 91 7%和 83 3%。     

先天性心脏病术后心律失常诊治经验

目的探讨先天性心脏病术后心律失常的诊断与治疗。方法对137例先天性心脏病术后心律失常的发生率、发病因素、治疗与转归进行总结分析。结果137例先天性心脏病患儿均经体外循环下直视心脏手术，手术后有56例发生89例次心律失常，发生率40．9％，其中激动起源异常31例次，以室上性心律失常多见，各型传导阻滞58例次，以完全性右束支传导阻滞最多。结论病因除手术因素外，以心功能不全、洋地黄中毒和电解质紊乱为主。除室内传导阻滞随访后未见恢复外，其他病例通过病因或抗心律失常治疗多数痊愈，有效率分别为91．7％和83．3％。     

小儿先天性心脏病术后心律失常的原因探讨和处理

心律失常是小儿心脏直视术后常见并发症之一,我们将1984年1月到1990年12月在我院胸外科住院治疗的先心病病人资料完整的88例进行归纳总结,分析心律失常发生原因,探讨预防和治疗措施。     

先天性心脏病患儿术后心律失常的机制及治疗

术后心律失常是先天性心脏病（先心病）患儿心脏外科手术后患病率与病死率高的主要原因之一。术后心律失常发生的机制不仅与部分先心病本身特殊的病理解剖及生理有关,且随外科技术的发展及新的外科技术采用而发生变化。先心病术后心律失常患者如治疗得当可长期维持窦性心律,减少患病率及病死率。     

小儿先天性心脏病术后心律失常诊治

先天性心脏病患儿发生心律失常,既与其心脏畸形有关,也可能是外科操作所致.抗心律失常治疗是基于快速和准确诊断.由于抗心律失常药物的负性肌力作用,药物治疗小儿心律失常时需权衡其利弊.近十年来,非药物治疗心律失常逐渐推广到儿科领域.     

先天性心脏病术后早期心律失常27例分析

目的 了解27例先天性心脏病患儿术后早期心律失常的种类和治疗效果.方法 选取2011年6月至8月在上海交通大学医学院附属上海儿童医学中心心胸外科行先天性心脏病手术,在术后早期出现各种心律失常,并进行1h动态心电图监测的患儿,共27例,对其术后早期心律失常进行分析.结果 27例患儿的中位年龄7个月（P25为0.6个月,P75为192个月）,中位体重为6 kg（P5为2.5 kg,P75为47 kg）,术后Holter检查监测心律失常的中位时间为术后25 h（P25为10 h,P75为146 h）.先天性心脏病术后早期心律失常以房性早搏、室性早搏为主,简单型先天性心脏病无恶性心律失常发生.复杂型先天性心脏病中,严重心律失常以交界性异位性心动过速多见,治疗给予静脉注射胺碘酮、降温治疗,死亡1例.结论 复杂型先天性心脏病术后易出现交界性异位性心动过速,发生时间多位于术后24 h内,及时发现并在降温、维持水、电解质平衡、合理使用抗心律失常药物和正性肌力药物治疗下,治疗效果良好.     

先天性心脏病相关的心律失常的临床研究

目的总结先天性心脏病患儿合并心律失常的类型及患病率。方法选择北京儿童医院2005年1月～2006年12月收治的793例先天性心脏病患儿为研究对象。所有患儿进行心电监测及十二导联心电图检查。结果共发现有128例患儿出现心律失常，其类型分别为：（1）束支传导阻滞97例（75．8％）；（2）Ⅰ度房室传导阻滞21例（14．2％），其中合并右束支阻滞5例（3．9％），加速性房性逸搏心律1例（0．8％）；（3）异位心律25例（19．5％），分别为加速性房性逸搏心律10例（7．8％），室性早搏8例（6．3％），单纯房性早搏5例（3．1％），室上性心动过速2例（1．6％）。结论先天性心脏病相关的心律失常以束支传导阻滞最常见，其次为Ⅰ度房室传导阻滞，异位心律最少见。易合并心律失常的先天性心脏病为室间隔缺损、房间隔缺损和心内膜垫缺损。心内膜垫缺损合并心律失常的发病率最高。     

胎儿先天性心脏病和心律失常的诊断及干预

目的 研究胎儿超声心动图产前诊断先天性心脏病（简称先心病）和经胎盘治疗胎儿心律失常的价值。方法 应用国产FECG－D型胎儿心电图仪筛查,结合胎儿超声心动图检测第1胎患先心病的460例胎龄为18－40周的高危胎儿,超声仪采用ALT、Maker LX和TOSHBA SSA 40A多普勒彩色超声仪,探头频率为3．5MHz。结果 发现先心病8例,同胞一级亲属患病率为1．7％。先心病的类型：房间隔缺损（简称房缺）3例（其中1例合并胎儿水肿）,室间隔缺损（简称室缺）13例（其中1例合并神经管缺损）,完全性的房室管缺损1例,法洛四联症1例。检出23例胎儿心律失常,检出率为5．0％,以室上性心动过速（简称室上速）最多见（13例）,首选地高辛经胎盘治疗,7例有效,其中3例合并先心病或心力衰竭者加用异博定2例有效,1例因有严重的非免疫性胎儿水肿而死亡;3例窦性心运过速（简称窦速）患儿用心得安治疗有效,1例频发室性早博用普鲁卡因酰胺治疗后转复。3例妊娠晚期的室上速和2例室上性早博未用药,经阴道分娩后转复。结论 胎儿超声心动图是产前诊断胎儿心脏异常的重要手段,地高辛是经胎盘治疗胎儿快速心律失常的首选药物。     

先天性心脏病手术后低心排综合征

低心排综合征(LCOS)是先天性心脏病手术后患者常见的并发症,病死率高。引起LCOS的病因种类很多,其病理生理机制相差甚远。深刻理解LCOS的病因和病理生理机制,有助于降低LCOS患者的发生率和病死率,改善患儿的预后。     

MRI技术在胎儿先天性心脏病诊断中的应用

先天性心脏病是造成新生儿死亡的主要原因之一.在产前对胎儿先天性心脏病进行诊断、评估预后是目前围生医学发展的重要内容.胎儿心脏彩超对于孕中期胎儿先天性心脏病的诊断具有相对较高的灵敏度,是胎儿先天性心脏畸形诊断的金标准.胎儿心脏核磁共振技术在过去十年内发展迅速,其视野大、可重复性好等优点在某些情况下可以弥补胎儿心脏超声的不足,但其技术上的问题也局限了其在临床上的应用,目前被认为是胎儿先天性心脏病的二线诊断方法.该文就胎儿心脏核磁共振技术在胎儿先天性心脏病诊断中应用的方法、优势以及局限性进行综述.     

Developmental status of young infants with congenital heart disease

BACKGROUND: Developmental status of young infants with congenital heart disease (CHD) is associated with physical and psychosocial factors. With the aim of obtaining basic data to perform developmental support, the study was conducted to examine the development and associated factors among these infants. METHODS: The Japanese Denver Developmental Screening Test was performed in 75 infants at 3-5 months of age, and a questionnaire was sent to their mothers about recognition of their child's development. Infants with and without developmental delay were compared using the characteristics of diagnosis of heart disease, symptoms and surgery, the state of growth of infants, and recognition of a child's development by its mother. To specify more adequate factors, a multiple logistic regression analysis was conducted. RESULTS: Of 75 infants, 14 (18.7%) had developmental delay. Weight gain of standard weight-2SD, Kaup index, and recognition of a child's development by mothers were associated with delayed development. In particular, infants gaining weight at <10 g/day were significantly more delayed than those gaining weight at >20 g/day. In addition, infants whose mothers recognized developmental delay were significantly delayed compared to those not recognized. CONCLUSIONS: Developmental status of young infants with CHD was found to be strongly associated with growth. In particular, weight gain <10 g/day appeared to be the critical point for delayed development, as well as mothers' recognition of their child's development.     

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??Objective To investigate the effect and safety of single dose of dezocine for anesthesia in children with cyanotic complex congenital heart disease on cardiac catheterization??and compare it with ketamine. Methods Sixty-four children with cyanotic complex congenital heart disease undergoing cardiac catheterization??under 6 years old?? between January 2014 and April 2015 in the First Hospital of Tsinghua University were randomly divided into intravenous dezocine??0.2 mg/kg?? group ??group D??n = 32?? and intravenous ketamine??2.0 mg/kg?? group ??group L??n = 32?? as soon as arriving at OR. All patients were inserted the laryngeal mask??LMA??after the same intravenous induction and the initial end-tidal concentration of sevoflurane was 2.0% to 2.5%. The time to lose consciousness??T1????mask assisted ventilation time??T2????anesthesia recovery time??T3????and such adverse reactions as airway spasm??respiratory depression??dysphoria??pain??nausea and vomiting were recorded. Results T1 of group D was significantly longer than that of group L??P??0.05??. T3 of group D was significantly shorter than that of group L??P??0.05??. The cases whose drop of SPO2 during induction and after extubation was greater than 20% and who needed suction more than twice in group D were fewer than in group L??P??0.05??. Conclusion Single dose dezocine of 0.2 mg/kg can be safely used in children with cyanotic complex congenital heart disease on cardiac catheterization??providing satisfactory sedation and analgesia??and the incidence of airway adverse reaction is lower than that of ketamine.     

Adult congenital heart disease: Past,present and future

The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success story of modern medicine. In the 1950s, survival of children born with CHD was only approximately 15%, whereas nowadays more than 90% of these children survive well into adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle‐aged adults but also patients with CHD over 60 years old. Many adult patients are afflicted by residual haemodynamic lesions and also face additional opportunities and/or challenges such as pregnancy, acquired heart disease, non‐cardiac pathology etc., necessitating integrated care and all medical disciplines. We are faced with a “tsunami” in terms of adult CHD numbers, disease heterogeneity and complexity of work and interventions needed. We need to secure resources, welcome more people in our field, learn from “marching with our patients”, and educate better patients, public and ourselves so that every single patient with CHD, born anywhere in the world, may reach their full life potential.     

Psychiatric morbidity in adolescents operated in childhood for congenital cyanotic heart disease

AIM: The aim of the present study was to assess psychiatric morbidity of adolescents operated in childhood for congenital cyanotic heart disease (CCHD) and their parents. METHODS: Participants were 31 adolescents (19 boys, 12 girls) aged 10-21 (mean +/- SD, 14.7 +/- 0.3) years, who had undergone cardiac surgery 13.7 +/- 2.48 years before the study assessment period. Twenty-two mothers and nine fathers participated in the study. Assessment tools for adolescents included: the UCLA Post Traumatic Stress Disorder-Reaction Index, The Screen for Child Anxiety Related Emotional Disorders, and The Beck Depression Inventory; for the parents: The Posttraumatic Stress Diagnostic Scale, The Spielberger State Trait Anxiety Inventory, and The Beck Depression Inventory. RESULTS: Nine out of 31 adolescents (29.03%) were defined as 'full post-traumatic stress disorder (PTSD) likely' with a total post-traumatic stress symptom (PTSS) score significantly higher than that of the non-PTSS subgroup (P < 0.001). A non-significant trend was noted for more adolescents with 'anxiety disorder likely' (P = 0.096, NS) in the PTSS versus the non-PTSS subgroups. A non-significant trend was detected showing that on all symptom domains of PTSD, as well as on anxiety and depressive measures, parents of children with PTSS received higher scores than parents of children without PTSS (P = 0.095, 0.03, 0.04, respectively, NS). CONCLUSION: Children undergoing cardiac surgery for CCHD may be at a high risk for long-term PTSS.     

复杂先天性心脏病的镶嵌治疗

近年随着小儿心导管技术的迅速发展,先天性心脏病已从以往的单纯手术治疗转变为手术和介入共同治疗.对于一些复杂的先天性心脏病,内科介入技术与外科手术相互结合的镶嵌治疗模式已经成为一个主要的发展方向,在围手术期应用介入技术支持外科手术可以达到更好的治疗效果.通过镶嵌治疗不仅可以提高治疗的效果,降低手术和介入治疗各自的风险,同时有利于手术方法的改良,也减轻了患者的痛苦和家庭的经济负担.     

Three-dimensional reconstruction of MR images in congenital heart disease

Commercially available software is now available for reconstructing three-dimensional (3D) images of hearts with congenital anomalies from standard two-dimensional (2D) tomographic slices We have used these 3-D images for 8 years to enhance anatomic diagnosis and functional evaluation pre- and postoperatively in children with congenital cardiac and great vessel diseases The advantages of 3-D imaging are reduced examination time, improved display of complex Intracranial relationships, better understanding of relationships between great vessels and adjacent major airways, and facilitated demonstration of cardiovascular anatomy for those unfamiliar with tomography images.