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目的分析婴幼儿先天性心脏病(CHD)术后肺出血原因和临床特点,探讨如何通过及时诊断和治疗降低CHD术后肺出血患儿的病死率。方法选择本院2000年3月-2008年11月心外科监护室23例CHD术后肺出血婴幼儿为研究对象,回顾性分析其原发病、临床表现、辅助检查结果及治疗过程。患儿均行体外循环,体外循环时间47～182min,阻断主动脉时间29～136min。13例术后即出现低心排综合征,1例术后11h二次开胸止血。术后14例气管插管内吸出大量粉色至血性痰液,9例在原有症状、体征加重基础上出现肺出血,出现肺出血的时间为术后第2-22天。肺出血后均行动脉血气分析,血小板计数检查,17例行凝血功能检查,21例行床边胸部X线片;肺出血后气管插管采用同步间歇性强制换气(SIMV)模式机械通气治疗,其中6例应用容量控制通气,其余病例采用压力控制通气;并予吸痰,经呼吸道应用1∶10000肾上腺素,输注凝血因子并积极治疗原发病及其他并发症。结果经机械通气等综合治疗后23例患儿原发病肺出血治愈出院9例(39%),肺出血死亡14例(61%),其中6例于肺出血出现3h内死亡。结论早期诊断,合理的机械通气,止血药物应用,积极治疗原发病等综合治疗是提高婴幼儿CHD术后肺出血存活率的关键。
Objective To analyze the causes and clinical features of pulmonary hemorrhage after congenital heart disease (CHD) in infants and young children, and to explore how to reduce the mortality of children with CHD postoperatively through timely diagnosis and treatment. Methods From March 2000 to November 2008, 23 infants with CHD postoperative pulmonary hemorrhage undergoing cardiac surgery in our hospital from March 2000 to November 2008 were selected as research objects. The primary disease, clinical manifestations, the results of auxiliary examination and the course of treatment were retrospectively analyzed. Children underwent cardiopulmonary bypass, cardiopulmonary bypass time 47 ~ 182min, blocking aortic time 29 ~ 136min. 13 cases of low cardiac output syndrome occurred after the operation, 1 case of 11 h after thoracotomy to stop bleeding. Postoperative 14 cases of endotracheal intubation sucked out a large number of pink to bloody sputum, 9 cases of the original symptoms, signs of pulmonary bleeding on the basis of exacerbations, pulmonary bleeding occurred after the first 2-22 days. Pulmonary hemorrhage were followed by arterial blood gas analysis, platelet count examination, coagulation test in 17 patients and chest X-ray in 21 patients. Simultaneous intermittent forced ventilation (SIMV) mode of mechanical ventilation was used to treat tracheal intubation after pulmonary hemorrhage Of which 6 were ventilated with volume-controlled ventilation and the rest were ventilated with pressure. Admission of sputum was performed using 1: 10,000 epinephrine through the respiratory tract, transfusion of clotting factors and active management of primary disease and other complications. Results After the primary treatment of mechanical ventilation, 23 cases were cured of primary pulmonary hemorrhage and discharged in 9 cases (39%). 14 cases died of pulmonary hemorrhage (61%), of which 6 cases died within 3 hours of pulmonary hemorrhage. Conclusions Early diagnosis, rational mechanical ventilation, hemostatic drug application and aggressive treatment of primary disease are the keys to improve the survival rate of pulmonary hemorrhage after CHD in infants.