摘要
目的探讨新生儿主动脉弓病变生后早期干预的意义及临床管理模式。方法回顾性分析2015年1月至2018年12月在青岛市妇女儿童医院心脏中心重症监护室(cardiac intensive care unit,CICU)诊断为主动脉弓病变并行手术治疗的新生儿临床资料,根据生后48 h内是否接受早期评估及干预分为早期干预组和晚期干预组。将两组患儿术前心率、呼吸频率、右上肢血压、差异性紫绀、动脉导管未闭、射血分数、凝血功能、肝功能、肾功能、气道狭窄、术前机械通气、急诊手术、术后机械通气时间、CICU滞留时间、并发症及病死率进行对比分析。结果纳入新生儿主动脉弓病变共34例,其中早期干预组9例,晚期干预组25例。晚期干预组患儿心率和呼吸较早期干预组显著增快[(152.0±14.4)次/min比(140.0±12.7)次/min,(50.7±15.9)次/min比(40.2±9.7)次/min],更易出现气道狭窄合并肺部感染(10/25比0/9),术前行机械通气(12/25比0/9)和急诊手术(13/25比1/9)比例增高,术前动脉导管更趋于闭合或已闭合(14/25比1/9),射血分数更低[60.0%(51.5%,63.5%)比67.0%(63.8%,69.5%)],右上肢血压升高[(95.0±16.7)mmHg比(81.6±9.9)mmHg],少尿甚至无尿比例增加(14/25比1/9),乳酸升高[4.0(1.4,12.7)mmol/L比1.0(0.8,1.7)mmol/L],差异均有统计学意义(P<0.05)。手术治疗后,两组患儿CICU滞留时间、机械通气时间、并发症及病死率差异均无统计学意义(P>0.05)。结论新生儿主动脉弓病变患儿可出现心力衰竭症状并迅速恶化,早期干预可有效改善患儿术前状态,为患儿手术创造有利条件。
Objective To study the importance of early intervention for neonates with congenital aortic arch lesions and different clinical management strategies.Method A retrospective review of neonates with aortic arch lesions who underwent corrective surgery in Qingdao Women and Children's Hospital from January 2015 to December 2018 was conducted.The patients were divided into two groups according to the intervention time:early intervention group within 48 hours of birth and late intervention group after 48 hours of birth.Comparative analysis of clinical data between the two groups was carried out,including preoperative heart rate,respiratory rate,right upper limb blood pressure,differential cyanosis,patent ductus arteriosus and left ventricular function(ejection fraction)on echocardiography,coagulation status,liver function,renal function,airway stenosis,preoperative mechanical ventilation,emergency surgery,postoperative mechanical ventilation time,postoperative length of stay in cardiac intensive care unit(CICU),complications and mortality.Result There were 34 cases meeting the diagnostic standards,among which 9 cases belonged to the early intervention group and 25 cases in late intervention group.The late intervention group had higher heart rate and respiratory rate at first assessment(P<0.05)[(152.0±14.4)bpm vs.(140.0±12.7)bpm,(50.7±15.9)bpm vs.(40.2±9.7)bpm].The late intervention group had higher rate of airway stenosis with pneumonia(10/25 vs.0/9),and higher rate of mechanical ventilation support(12/25 vs.0/9)and emergency operation(13/25 vs.1/9),the differences were statistically significant(P<0.05).As the ultrasound cardiogram showed the most ductus arteriosus in late intervention group had closed or been closing(14/25 vs.1/9),the cardiac function and ejection fraction were significantly reduced[60.0%(51.5%,63.5%)vs.67.0%(63.8%,69.5%)].The late intervention group had higher right upper limb blood pressure[(95.0±16.7)mmHg vs.(81.6±9.9)mmHg],oliguria even anuria(14/25 vs.1/9),and lactic acidosis[4.0(1.4,12.7)m
作者
吕蓓
杜占慧
陈瑞
邢鹏超
任悦义
全贤洲
邢泉生
Lyu Bei;Du Zhanhui;Chen Rui;Xing Pengchao;Ren Yueyi;Quan Xianzhou;Xing Quansheng(The Heart Center,Qingdao Women and Children's Hospital,Qingdao 266043,China)
关键词
主动脉弓病变
主动脉弓中断
主动脉弓缩窄
主动脉弓发育不良
临床管理
Congenital aortic arch lesions
Interrupted aortic arch
Coarctation of aorta
Hypoplastic aortic arch
Clinical management
