本文選題：右位心　切入點(diǎn)：內(nèi)臟反位　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討右位心的病因、臨床表現(xiàn)、合并癥、檢查手段、治療及預(yù)后。旨在進(jìn)一步探索右位心的早期干預(yù)措施，以提高患兒的成活率和生存質(zhì)量。 方法：回顧性分析重慶醫(yī)科大學(xué)附屬兒童醫(yī)院自1993年2月至2013年1月收治的70例右位心患兒住院病例資料，，并通過(guò)門診隨訪及電話隨訪了解預(yù)后情況。從一般情況、臨床表現(xiàn)、診斷方法及治療預(yù)后方面分別進(jìn)行分析。 結(jié)果： 1.70例右位心患兒中，初診年齡為0天～16歲8月（中位年齡5月），68.6%于嬰兒時(shí)期首次診斷。男40例，女30例，男女比例：1.33:1。其中居于城鎮(zhèn)44例（62.9%），鄉(xiāng)村26例（37.1%）。 2.本組資料中鏡像右位心26例（37.1%）、右旋心29例（41.5%）、右移心15例（21.4%）。 3.臨床表現(xiàn)主要為心尖搏動(dòng)點(diǎn)、最大心界、最強(qiáng)心音均在右側(cè)，發(fā)紺(27.1%)，氣促(41.4%)，心臟雜音(40%)，生長(zhǎng)發(fā)育遲緩(27.1%)。單純心臟位置異常者4例（5.7%），心臟位置異常+心血管結(jié)構(gòu)畸形18例（25.7%），心臟位置異常+心血管結(jié)構(gòu)畸形+內(nèi)臟反位15例（21.4%），心臟位置異常+心血管結(jié)構(gòu)畸形+其他畸形10例（14.3%），心臟位置異常+心血管結(jié)構(gòu)畸形+內(nèi)臟反位+其他畸形3例（4.3%），心臟位置異常+內(nèi)臟反位7例（10%），心臟位置異常+其他畸形10例（14.3%），心臟位置異常+內(nèi)臟反位+其他畸形3例（4.3%）。 4.本組資料中右位心常見(jiàn)并發(fā)癥：肺炎45例（64.3%），肺動(dòng)脈高壓9例（12.9%），心力衰竭5例（7.1%）。 5.本組資料右位心行胸片檢查57例（81.4%）、超聲心動(dòng)圖檢查65例（92.9%）、胸部CT檢查12例（17.1%）、心導(dǎo)管檢查4例（5.7%）、心電圖檢查26例（37.1%）。 6.本組資料中，無(wú)心血管結(jié)構(gòu)畸形者24例(34.3%)，其中3例為右移心合并心外畸形，行原發(fā)疾病手術(shù)治療，除死亡1例外，預(yù)后較好。合并心血管結(jié)構(gòu)畸形者46例（65.7%），其中外科手術(shù)治療者13例，死亡2例，放棄治療1例，余10例預(yù)后較好。心導(dǎo)管介入治療1例，預(yù)后好。未手術(shù)治療者32例，死亡5例，放棄治療15例，目前一般情況尚可者12例。 7.母孕期主要異常情況：孕早期感染21例（30%）、母孕期藥物使用7例（10%）、高齡產(chǎn)婦6例（8.6%）。父母重要疾病史：母親自然流產(chǎn)或死胎史4例（5.7%）、父親慢性疾病3例（4.3%）。 結(jié)論： 1．右位心臨床表現(xiàn)多種多樣，主要表現(xiàn)為心尖搏動(dòng)點(diǎn)、最大心界、最強(qiáng)心音均在右側(cè)，心臟雜音，發(fā)紺，氣促，生長(zhǎng)生長(zhǎng)發(fā)育遲緩。 2．右位心常合并心血管結(jié)構(gòu)畸形，最常見(jiàn)的并發(fā)癥為肺炎。 3．超聲心動(dòng)圖是診斷、隨訪右位心及心內(nèi)結(jié)構(gòu)畸形的首選方法。 4.右位心合并心血管結(jié)構(gòu)畸形、心外畸形者，需外科手術(shù)或心導(dǎo)管介入治療。 5.孕早期的感染可能是導(dǎo)致右位心形成的重要危險(xiǎn)因素。
[Abstract]:Objective: to explore the etiology, clinical manifestation, complications, examination, treatment and prognosis of right heart. Methods: the data of 70 patients with right heart disease admitted from February 1993 to January 2013 in Children's Hospital affiliated to Chongqing Medical University were analyzed retrospectively, and the prognosis was analyzed through outpatient follow-up and telephone follow-up. The clinical manifestations, diagnostic methods and treatment and prognosis were analyzed respectively. Results:. 1.The first diagnosis age was 0 days and 16 years old on August (median age May) was 68.6%. Male 40 cases, female 30 cases, the ratio of male to female was 1.33: 1.44 cases were living in town, 62.9% were in town, 26 cases were in rural area. 2. There were 26 cases of mirrored right heart, 29 cases of right circumflex heart, and 15 cases of right shift. 3. The clinical manifestations were mainly apical pulsation point, maximal cardiac boundary, and strongest heart sound on the right side. Cyanosis 27.1D, shortness of breath 41.4m, cardiac murmur 40m, growth retardation 27.1g. There are only 4 cases with abnormal cardiac position, 18 cases with abnormal cardiac position, 18 cases with cardiovascular structural malformation, 15 cases with abnormal cardiac position malformation, 15 cases with visceral counterposition, and 21.41C with abnormal cardiac position. Abnormal visceral position Cardiovascular malformation other malformation 10 cases Cardiovascular structural malformation 10 cases Cardiovascular malformation Cardiovascular malformation Cardiovascular malformation other malformation of visceral antiposition 3 cases other deformity of visceral inversion 7 cases of abnormal position of heart 7 cases of abnormal visceral inversion and abnormal position of heart. There were 10 cases of his malformation and 3 cases of other deformities with abnormal heart position and visceral inversion. 4. The common complications of right heart in this group were pneumonia in 45 cases (64.3%), pulmonary hypertension in 9 cases (P < 0.01), heart failure in 5 cases (P < 0.01). 5. Right chest radiography was performed in 57 cases, echocardiography in 65 cases (92.9%), chest CT in 12 cases (17. 1%), cardiac catheterization in 4 cases (5. 7%), electrocardiogram in 26 cases (37. 1%). 6. In this group, 24 patients without cardiovascular structural malformation were diagnosed as right heart shift combined with extracardiac malformation, 3 of them underwent surgical treatment of primary diseases, except for one death, 3 of them were diagnosed as right heart shift combined with extracardiac malformation. The prognosis was better in 46 patients with cardiovascular structural malformation, including 13 cases of surgical treatment, 2 cases of death, 1 case of abandonment of treatment, and 10 cases of better prognosis. Cardiac catheterization was performed in 1 case, prognosis was good in 32 cases, and no surgical treatment was performed in 32 cases. 5 cases died, 15 cases gave up treatment, 12 cases were normal at present. 7. The main abnormal conditions during pregnancy were as follows: 21 cases of early pregnancy infection, 7 cases of drug use during pregnancy, and 6 cases of elderly women, respectively. The history of important diseases of parents: 4 cases of spontaneous abortion or stillbirth history of mother, 3 cases of father's chronic disease, 3 cases of father's chronic disease. Conclusion:. 1. The clinical manifestations of right heart were varied, including apical pulsatile point, maximal cardiac boundary, strongest heart sound on the right side, cardiac murmur, cyanosis, shortness of breath and growth retardation. 2. Right heart is often associated with cardiovascular malformation. Pneumonia is the most common complication. 3. Echocardiography is the first choice in the diagnosis and follow-up of right ventricular and intracardiac malformations. 4. The right heart with cardiovascular malformation or extracardiac malformation should be treated by surgery or cardiac catheterization. 5. Infection in early pregnancy may be an important risk factor for right ventricular formation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R725.4

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