主动脉弓离断患儿的术后护理

对5例主动脉弓离断患儿实施一期根治术治疗,结果 均获得成功救治,顺利康复出院.提出除了严格执行小儿先天性心脏病体外循环术后常规护理外,严密监测上、下肢血压,积极维护心、肺等各个重要脏器的功能.有效降低肺动脉压力,持水电解质及酸碱平衡,可有效预防术后各种并发症,如吻合血管的堵塞,肺高压危象,心、肺、肾功能不全,异常出血及脑损害等,提高患儿救治效果.     

主动脉弓中断合并心内畸形的外科治疗

主动脉弓中断是一种罕见的先天性心脏病 ,多数病例靠并发的其他心内畸形提供血流动力学通道 ,以维持生命需要 ,如治疗不及时 ,很快发生严重的充血性心力衰竭等并发症。近十年来 ,我们采用外科治疗 5例主动脉弓中断合并其他心内畸形的病儿 ,现将治疗经验总结如下。临床资料　本组 5例中男 3例 ,女 2例 ;年龄 5～ 8岁 ;体重 14～ 2 2 5ｋｇ。均有运动性心悸、气短。右上肢血压 82 5 /5 2 5～ 180 0 / 90 0ｍｍＨｇ(1ｍｍＨｇ =0 .133ｋＰａ) ,下肢血压30 0 / 0～ 12 0 0 / 90 0ｍｍＨｇ。 4例术前确诊且均伴有动脉导管未闭和室间隔缺…     

一期手术矫治主动脉弓缩窄合并心内畸形

目的：探讨主动脉弓缩窄合并心内畸形病人的一期手术矫治方法及治疗效果。方法：自１９８９年１２月至１９９８年２月,运用一期手术方法为１０例主动脉弓缩窄合并心内畸形病人进行外科矫治。合并的心内畸形有室间隔缺损７例,二尖瓣关闭不全２例,主动脉瓣狭窄１例;６例同时合并动脉导管未闭。采用左后外侧切口矫治主动脉弓缩窄,正中切口行心内畸形矫治６例、正中切口采用主肺动脉内隧道同时矫治主动脉弓缩窄及合并心内畸形３例;     

脾切除责门周围血管离断术的围术期护理

肝移植的出现使门静脉高压症的治疗格局发生了根本改变，但是，手术复杂、开展单位少，供体短缺、费用昂贵、术后长时期的免疫抑制治疗是我们面临的重要难题。因此，就我国的具体国情而言，对于相当一部分门静脉高压症食管胃底静脉出血的患者，我们依然要采用脾切除贲门周围血管离断术来预防再出血的发生，同时解决脾功能亢进问题。     

B型主动脉弓离断畸形综合征1例

病儿　男 ,10岁。自幼发现心脏杂音伴轻度发绀。左上肢及双下肢脉搏微弱 ,心前区隆起 ,第 2～ 4肋间闻及 3/ＶＩ级收缩期杂音。Ｐ2 亢进、固定分裂。经心电图、Ｘ线胸片、彩色超声、心导管和心脏造影检查 ,确诊为Ｂ型主动脉弓离断畸形 (ＩＡＡ)、ＩＩＩ型主—肺动脉窗、动脉导管未闭 (ＰＤＡ)。胸骨正中切口手术。心外探查见右心室圆隆、无震颤 ,左心室大。升主动脉直径 2 5ｃｍ ,长 3 0ｃｍ ,远端直径 1 2ｃｍ ,长 1 5ｃｍ ,继而分为右无名和左颈总动脉 ,肺动脉干直径4 0ｃｍ ,长 3 0ｃｍ ,左、右肺动脉直径 2 0ｃｍ ,ＰＤＡ 1 5ｃｍ。…     

一期矫治合并主动脉弓病变的心内畸形

1993年以来，我们收治了14例合并多种心内畸形的主动脉弓发育不良或主动脉缩窄病儿，均经胸骨正中切口在体外循环下行同期矫治，取得了满意疗效，现报道如下。     

多指离断伤的围手术期护理

多指离断伤是指有两个手指以上的离断伤，多数患者损伤较重，疼痛剧烈。如果在手术前后护理不当，容易发生感染、血管危象等而导致断指再植手术的失败。因此，笔者总结了286例多指离断伤的围手术期护理，现报告如下。     

Down综合征合并先天性心脏病患儿心内畸形矫治术的围术期护理

Down综合征（Down Syndrome，DS）又称21-三体综合征、先天愚型，是以智力发育障碍、肢体异常、特殊面容、心脏畸形为主要特征的遗传综合征。据报道，44％的DS合并有先天性心脏病。此类患儿病情复杂，且存往多种先天性发育异常的基础病变．早期易发展为肺动脉高压，手术风险性大，     

Down综合征合并先天性心脏病患儿心内畸形矫治术的围术期护理

<正>Down综合征(Down Syndrome,DS)又称21-三体综合征、先天愚型,是以智力发育障碍、肢体异常、特殊面容、心脏畸形为主要特征的遗传综合征。据报道44%的DS合并有先天性心脏病[1],此类患儿病情复杂,且存在多种先天性发育异常的基础病变,早期易发展为肺动脉高压[2,3],手术风险性大,手术后合并症多,死亡率高。因此,围手术期护理对于手术的成败和减少并发症的发生尤为重要。     

先天性主动脉弓中断及合并畸形的一期手术治疗

目的回顾总结先天性主动脉弓中断及合并畸形一期手术治疗经验。方法1988年7月至2004年8月,手术治疗主动脉弓中断及合并畸形20例。男12例,女8例;手术年龄18d～9岁。其中<1岁者10例,平均年龄(3.37±2.45)个月,平均体重(5.33±1.72)kg;>1岁者10例,平均年龄(2.60±1.24)岁,平均体重(13.10±6.53)kg。所有病儿术前均有反复呼吸道感染史。A型15例,B型5例。2例经双切口手术,即先通过左后外侧切口纠治主动脉弓中断,再经正中切口纠治合并畸形。18例采用正中切口同时纠治主动脉弓中断和合并畸形。结果全组死亡3例,死于术后严重肺动脉高压危象2例、严重心功能衰竭1例。17例随访3个月～12年,均恢复良好。结论主动脉弓中断采用正中切口方法,操作简便,暴露清楚,创伤小,有利于术后恢复。本病早期即出现肺动脉高压,临床上一经确诊宜尽早手术。     

一期手术纠治婴幼儿主动脉缩窄或离断合并心内畸形

目的 总结婴幼儿主动脉缩窄或离断合并心内畸形胸骨正中切口一期纠治的外科治疗策略.方法 2004年5月至2010年3月,采用胸骨正中切口一期纠治主动脉缩窄或离断合并心内畸形患儿52例.其中男性32例,女性20例;年龄25 d～7个月,平均(2.03±0.15)个月;体质量3.5～8.0 kg,平均(3.9±0.5)kg.采用自体心包片修补心内缺损;主动脉缩窄者40例,34例采用端侧吻合或扩大端侧吻合术,3例行纵切横缝术,3例假性主动脉缩窄行导管韧带切断主动脉松解;主动脉离断12例,均采用扩大端侧吻合.结果 所有病例心肺转流时间平均为(98±41)min,术中出血量(78±13)ml.1例主动脉离断合并右心室双出口患儿术后因左侧支气管狭窄,脱离呼吸机困难,于术后43 d死亡.其余病例术后生存良好,随访1～6年,术后再缩窄率为11%.结论 采用胸骨正中一期切口纠治主动脉缩窄或离断近期手术效果显著,可避免二次手术.

Abstract：

Objective To sum up one-stage complete correction of infantile aortic coarctation (CoA) or interrupted aortic arch (IAA) associated with intracardiac anomailes through median sternotomy.Methods The clinical data of 52 infants with CoA or IAA associated with intracardiac anomalies from May 2004 to March 2010 was analyzed. There were 32 male and 20 female, aged from 25 d to 7 months with a mean of (2.03 ±0. 15) months, weighted from 2.5 to 8.0 kg with a mean of (3.9 ±0.5) kg. All of intracardia defect were corrected by self-arcula cordisand. Forty cases with CoA were underwent by operative techniques, including resection with end to side anastomosis, extented end to side anastomosis (n = 34),and vertical incision and cross joint ( n = 3). Three cases of pseudo-CoA were cuted and ductus arterissus or ligamentum arteriosus and dissected aorch. Twelve cases of IAA were underwent by extented end to side anastomosis. Results The time of cardiopulmonary bypass was (98 ± 41 ) min, and all patients hemorrhaged (78 ± 13) ml during operation. One case of IAA associated with double outlet right ventricle died after 43 d post-operation because of left bronchinal stenosis. The other patients were in good condition.The rate of aneurysm formation was 11% in 1 to 6 years' follow-up. Conclusions One-stage complete correction of infantile CoA or IAA associated with intracardiac anomailes through median sternotomy yieldes excellent intermediate surgical results. This operative approach is beneficial, not only with shorten period of therapy and loss operative cost.     

Staged surgical repair for infants with interrupted aortic arch

BackgroundInterrupted aortic arch (IAA) is a rare congenital cardiac anomaly, which necessitates surgical treatment. There are several surgical strategies for corrective repair of IAA, such as one-stage repair, rapid two-stage repair and two-stage repair. Here, we reported our surgical result of staged-repair policy for the patients with IAA.MethodFrom November 2003 to July 2015, there were 14 patients (8 boys, 6 girls) with IAA treated by us. Except one teenager patient, we routinely used intravenous infusion of prostaglandin E1 for all the infant patients (n = 13) to keep adequate end organ perfusion before the first surgical intervention. Surgical repair was performed after the perfusion of end organs recovered.ResultTwo patients (1 teenager and 1 infant with one-stage surgery) were excluded from this study. At the time of the first surgery, we did the first-stage surgery with anastomosis in between aortic arch and descending aorta, division of patent ductus arteriosus and banding of pulmonary trunk through left thoracotomy. The overall surgical survival rate of the first surgery was 100% (12/12). At the time of the second surgery, corrective repair was done under cardiopulmonary bypass through median sternotomy. The surgical survival rate of the corrective surgery was also 100%. There is no late death during follow-up for 9 years (range 4.2–15.0 years).ConclusionOut of several surgical strategies for the infants with IAA, staged repair still could be a treatment option to achieve satisfied surgical result.     

One stage repair of aortic arch anomalies and intracardiac defects

Between August 1985 and May 1990, 27 neonates and infants underwent combined correction of intracardiac and aortic arch anomalies through a median sternotomy. Coarctation (CoA) was combined with VSD (6), AVSD (2), Taussig-Bing (TB) heart (5), transposition of the great arteries (TGA) (1), TGA + VSD (2), congenitally corrected TGA + VSD (1) and VSD + myxoid stenotic outlet valves (1). Interrupted aortic arch (IAA) was combined with VSD (10) and TB heart (1). Two patients had IAA type B as well as CoA. Age at operation varied from 2 to 243 days with a mean age of 51 days. Twenty patients (70%) were younger than 30 days. One TGA + VSD and all TB hearts had maligned outlet septum and right ventricular outflow tract obstruction (RVOTO). Posterior outlet septum deviation and left ventricular outflow tract obstruction (LVOTO) occurred in 8 patients with malalignment VSD and IAA (7) or CoA (1). Aortic arch reconstruction was performed using extended end-to-end anastomoses. In 3 patients, arch hypoplasia necessitated patch implantation. VSDs were closed through the right atrium unless the anatomy dictated otherwise. One TB heart was reconstructed with a Kawashima procedure. All other TB hearts and all TGAs were corrected with arterial switch operation. Obstructing outlet septum was resected whenever necessary. Follow-up was complete and included echo-Doppler control. Eleven patients had postoperative heart catheterisation. Early mortality was 18.5% (5 patients). Persisting LVOTO or RVOTO was responsible. There was no late mortality. Five patients were reoperated upon: 3 for stenotic anastomoses and 2 for a subaortic membranous stenosis. Successful balloon dilatation of recoarctation was performed four times.(ABSTRACT TRUNCATED AT 250 WORDS)     

主动脉缩窄或主动脉弓中断合并心内畸形一期修复

目的 探讨采用经胸骨正中切口一期修复主动脉缩窄(CoA)或主动脉弓中断(IAA)合并心内畸形的治疗效果.方法 2002年7月至2009年6月,经胸骨正中切口行降主动脉远端和主动脉弓下缘端侧吻合术一期修复CoA或IAA合并心内畸形病儿43例,其中CoA 34例,IAA 9例(A型6例、B型3例),合并心内畸形包括室间隔缺损42例、动脉导管未闭34例、房间隔缺损12例、主动脉瓣下隔膜狭窄5例、二尖瓣关闭不全2例,右心室双出口1例.结果 手术死亡1例,为术后肺动脉高压和严重低心排血量综合征者.术后并发症包括严重低心排血量综合征3例,低氧血症6例,肺部炎症11例,肺不张14例,声音嘶哑19例,室上性心动过速23例.8例失访.34例随访3个月～5年,生活质量明显改善,心脏超声心动图和CT检查显示吻合口无明显再缩窄发生.结论 经胸骨正中切口,采用主动脉远端和主动脉弓下缘端侧吻合技术一期修复CoA或IAA合并心内畸形的手术早、中期效果良好,能明显减少术后再狭窄.     

Surgical treatment of coarctation and interrupted aortic arch complex in infants

One hundred forty-two consecutive neonates or early infants with coarctation and interrupted aortic arch complex who underwent biventricular repair at the Fukuoka Children's Hospital between January 1991 and December 2000 were reviewed. One-stage repair was performed in 33 patients (35%) with coarctation complex and in 41 patients (85%) with interrupted aortic arch complex. The overall mortality rate was 6.1% in one-stage repair and 6.6% in two-stage repair of coarctation complex patients and 9.8% in one-stage repair and 28.6% in two-stage repair of interrupted aortic arch complex patients. The recoarctation rate was 5.3% in coarctation complex and 2.1% in interrupted aortic arch complex. All patients with recoarctation underwent successful catheter intervention and required no reoperation. In conclusion, one-stage repair of interrupted aortic arch and coarctation complex with the anterior approach resulted in good outcomes. Then descending aorta cannulation through a median sternotomy combined with the cerebral perfusion technique enables complete avoidance of circulatory arrest and is a useful technique. However, a two-stage procedure can be useful in the patients whose condition has deteriorated substantially or in whom intracardiac anomalies are severe.     

Off pump repair of aortic arch anomalies with concomitant intracardiac defects via anterior approach

BACKGROUND: The authors evaluated the surgical treatment of aortic arch anomalies associated with intracardiac pathologies, through median sternotomy on beating heart without using cardiopulmonary bypass (CPB). METHODS: A consecutive series of 10 patients with aortic coarctation were operated upon. Median age at repair was 3.5 months (range, 5 days to 72 months), median weight was 4 kg (range, 2.2 to 30 kg). All aortic obstruction repairs were done via midsternotomy without using CPB and it is used only for repair of intracardiac defects. The aortic reconstruction included resection and end-to-side anastomosis in six patients and pulmonary autograft patch aortoplasty in four patients. RESULTS: There was no operative mortality. Mean follow-up value was 17.6 +/- 8.07 months. There was no restenosis. CONCLUSION: Most of the aortic coarctation and interrupted aorta type A can be well-treated surgically through median sternotomy without using CPB. Thus, the need for profound hypothermia and circulatory arrest and its potential neurological and other side effects are removed and CPB is reserved only for associated intracardiac defects, if present.     

新生儿、婴幼儿期主动脉弓中断一期矫治效果分析

目的 探讨新生儿、婴幼儿期主动脉弓中断一期矫治手术早、中期效果以及有关死亡风险因素.方法 回顾性分析1988年7月至2008年6月期间连续72例主动脉弓中断伴有合并畸形的一期矫治手术效果,其中63例手术中采用改良端侧直接吻合技术重建主动脉弓,9例在吻合的前壁用补片扩大成形;采用Logistic多元线形回归分析和评估早、中期结果以及有关影响手术后效果的危险因素.结果 住院总生存率83.4%,手术后0.5、2、5、10年生存率分别为98%、96%、96%、95%.与术后死亡有关危险因素是大年龄(P=0.018)、合并复杂畸形(P=0.001)、术前状况(P＝0.01)和肺动脉高压危象(P=0.014).结论 一期矫治主动脉弓中断以及合并畸形的早、中期预后好,重建主动脉弓采用直接端侧吻合技术以及适宜补片扩大效果佳,术前年龄和状况影响术后早期结果.     

Surgical treatment of persistent fifth aortic arch associated with interrupted aortic arch

This study describes two cases of the rare congenital anomaly, persistent fifth aortic arch. Both cases involve boys (1 at 9 years of age and another at 7 months of age). To detect persistent fifth aortic arch with interrupted aortic arch, the following methods were used: echocardiogram, angiocardiography, and magnetic resonance imaging. In both cases the blood pressure between the upper and lower limbs differed. To relieve the obstruction of blood flow, each case was surgically repaired using patching or conduit interposition. Postoperative courses were uneventful. Two-year to 5-year follow-up examinations were positive showing that the anastomosis was unobstructed and the velocity of blood flow to the descending aorta was normal.