本文選題：先天性室間隔缺損　切入點(diǎn)：嬰幼兒　出處：《河北醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:室間隔缺損(ventricular septal defect,VSD)是先天性心臟病中最常見類型,占全部先天性心臟病的20%~57%[1],一般通過手術(shù)的治療可以獲得良好的效果。無特殊并發(fā)癥的先心病嬰幼兒可以在學(xué)齡前選擇根治手術(shù)治療。但嬰幼兒期由于年齡小、體重低、全身各個(gè)臟器發(fā)育不成熟,同時(shí)存在心內(nèi)解剖畸形,大量的左向右分流,導(dǎo)致肺循環(huán)充血、肺動(dòng)脈高壓,進(jìn)一步造成心肺功能損害,在早期容易出現(xiàn)反復(fù)呼吸道感染進(jìn)而迅速發(fā)展為重癥肺炎,甚至死亡。部分患兒經(jīng)內(nèi)科系統(tǒng)治療后未見明顯好轉(zhuǎn),甚至并發(fā)多臟器衰竭,危及患兒生命。近年來,隨著手術(shù)方式、麻醉、體外循環(huán)等技術(shù)的提高以及監(jiān)護(hù)設(shè)備的不斷完善,逐漸擴(kuò)大了先心病手術(shù)適應(yīng)癥,現(xiàn)普遍認(rèn)為對(duì)嬰幼兒先天性心臟病肺炎進(jìn)展為呼吸衰竭并發(fā)心力衰竭者經(jīng)內(nèi)科治療無明顯好轉(zhuǎn)時(shí)建議盡早手術(shù),有助于阻斷心內(nèi)左向右分流,緩解炎癥,避免重要臟器損害。故選擇2014年1月~2015年4月我院收治室間隔缺損合并肺炎患兒共60例,依據(jù)是否帶氣管插管行急癥手術(shù)分為兩組,均行手術(shù)治療,效果良好。分析其臨床診治資料,并探討手術(shù)時(shí)機(jī)以及圍手術(shù)期的治療以有效的降低死亡率,減少住院天數(shù),改善患兒生存質(zhì)量。方法:回顧性分析2014年1月至2015年4月我院收治的1歲以下室間隔缺損合并肺炎患兒60例其中男26例,女34例,年齡0.7~10(4.5±2.3)個(gè)月,體質(zhì)量3.3~10.67(5.07±2.04)kg,依據(jù)是否帶氣管插管行急癥手術(shù)治療分為急癥手術(shù)組和擇期手術(shù)組,各30例�；純壕谌轶w外循環(huán)下行VSD修補(bǔ)術(shù),同期矯治心內(nèi)合并畸形,觀察臨床指標(biāo),并進(jìn)行比較。結(jié)果:擇期手術(shù)組30例中患兒術(shù)后經(jīng)積極改善心功能不全,控制感染,營(yíng)養(yǎng)支持等綜合治療后29例治愈出院,占96.6%,1例患兒家屬因經(jīng)濟(jì)問題放棄治療,其余術(shù)后恢復(fù)良好。手術(shù)后至出院時(shí)間為6~16 d,平均為(9.50±3.27)d,CICU滯留時(shí)間為2C15(6.4±3.2)d,呼吸機(jī)輔助時(shí)間為9~335h(88.1±60.9)h,總住院天數(shù)9~29(15.5±5.1)d。帶機(jī)行急癥手術(shù)組30例患兒中28例治愈出院,圍手術(shù)期死亡1例,早期隨訪死亡1例,病死率6%。手術(shù)后至出院時(shí)間為6~17 d,平均為(9.60±2.41)d,CICU滯留時(shí)間為4~16(7.3±2.7)d,呼吸機(jī)輔助時(shí)間為23.7~219.8h(101.5±44.7)h,總住院天數(shù)12~34(20.7±6.4)d。對(duì)比兩組的主動(dòng)脈阻斷時(shí)間、體外循環(huán)時(shí)間、術(shù)后呼吸機(jī)輔助時(shí)間,ICU滯留時(shí)間未見明顯差異。術(shù)后并發(fā)癥主要為再次氣管插管、心律失常、肺不張、乳糜胸、手術(shù)切口感染。兩組患兒門診隨訪6個(gè)月體重、身高、患病情況,兩組患兒術(shù)后生長(zhǎng)發(fā)育均明顯加快,體質(zhì)較前增強(qiáng),發(fā)生感染性疾病幾率明顯減少。術(shù)后1~2個(gè)月心臟專科門診隨訪心臟彩超示心功能均恢復(fù)良好。結(jié)論:嬰幼兒室間隔缺損合并肺炎,大部分經(jīng)內(nèi)科保守治療可痊愈而擇期手術(shù)。但部分患兒因年齡小、缺損大、肺炎重,心功能不能控制時(shí),應(yīng)盡早進(jìn)行手術(shù)治療,降低死亡率,改善患兒生存質(zhì)量,減輕家庭負(fù)擔(dān)。
[Abstract]:Objective: ventricular septal defect (ventricular septal defect, VSD) is the most common type of congenital heart disease, congenital heart disease accounted for 20%~57%[1], usually by surgical treatment can get good results. No special complications in infants with congenital heart disease in preschool choose radical surgery. But due to the small age infants low weight, various body organs, development is not mature, exist within the heart anatomic deformity, a left to right shunt, leading to pulmonary congestion, pulmonary hypertension, heart and lung function caused further damage in early phase is prone to recurrent respiratory tract infection and the rapid development of severe pneumonia, and even death. Some patients after medical treatment system there was no obvious improvement, even complicated with multiple organ failure, endangering the lives of children. In recent years, with surgery, anesthesia, cardiopulmonary bypass technique and the improvement of monitoring equipment Continue to improve, gradually expanded the indications for surgery of congenital heart disease, it is generally believed that the development of pneumonia in infants with congenital heart disease complicated with heart failure patients for respiratory failure after medical treatment was not improved when the proposed operation as soon as possible, to help block the left to right shunt heart, relieve inflammation, avoid damage to important organs. The choice of ~2015 in January 2014 in April, children in our hospital were ventricular septal defect complicated with pneumonia in 60 cases, according to whether with tracheal intubation in emergency operation were divided into two groups, underwent surgical treatment, the effect is good. To analyze the clinical data, and to investigate the timing of surgery and perioperative treatment to reduce mortality, reduce hospitalization time, improve the quality of the survival of children. Methods: a retrospective analysis from January 2014 to April 2015 in our hospital room under the age of 1 VSD with pneumonia in 60 cases including 26 cases of male, female 34 cases, aged 0.7~10 (4.5. 2.3) months, the body weight of 3.3~10.67 (5.07 + 2.04) kg, according to whether with tracheal intubation in emergency operation treatment is divided into emergency surgery group and elective surgery group, 30 cases each. The patients were under general anesthesia under extracorporeal circulation VSD repair treatment at the same time, heart malformation, clinical observation index, and compared. Results: 30 cases of elective surgery group in patients after active heart dysfunction, infection control, nutritional support after the comprehensive treatment of 29 cases were cured, accounting for 96.6%, 1 cases of children with their families because of economic problems to give up treatment, the rest recovered well after operation. After the operation to discharge time was 6~16 D, average (9.50 + 3.27) d, CICU for 2C15 retention time (6.4 + 3.2) d, 9~335h ventilation time (88.1 + 60.9) h, the total length of stay in 9~29 (15.5 + 5.1) d. with emergency surgery group 30 cases 28 cases were cured, 1 cases of perioperative death, follow-up 1 cases of early death, the mortality rate was 6% . after surgery to discharge time was 6~17 D, average (9.60 + 2.41) d, CICU for 4~16 retention time (7.3 + 2.7) d, 23.7~219.8h ventilation time (101.5 + 44.7) h, the total length of stay in 12~34 (20.7 + 6.4) d. between two groups of aortic clamp time and cardiopulmonary bypass between the ventilation time after operation, the ICU residence time had no significant difference. The main complications were again tracheal intubation, arrhythmia, pulmonary atelectasis, chylothorax, incision infection. Two groups of children with outpatient follow-up 6 months of weight, height, the prevalence of children in two groups after operation were significantly accelerated growth and development, physical fitness compared with the previous increase of infectious diseases rate decreased significantly. After 1~2 months of cardiology outpatient follow-up echocardiogram showed cardiac function recovered well. Conclusion: ventricular septal defect in infants with pneumonia, most can be cured by conservative treatment and elective surgery. But some patients because of When the age is small, the defect is large, the pneumonia is heavy and the heart function can not be controlled, the operation should be carried out as soon as possible to reduce the death rate, improve the quality of the children's life and reduce the family burden.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R726.5

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