主动脉弓离断21例临床分析

来源 :中国实用儿科杂志 | 被引量 : 0次 | 上传用户:utpaxiao
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的分析主动脉弓离断(IAA)的发病情况,总结诊断和治疗经验。方法回顾性分析复旦大学附属儿童医院1995—2004年收治的21例IAA患儿的临床资料。结果21例IAA患儿年龄在12d至11岁(中位数1·5个月),男11例,女10例。占同期先天性心脏病患儿的0·1%。其中A型18例(占85·7%),B型3例(占14·3%),无C型病例。所有病例均合并粗大动脉导管未闭及大型室间隔缺损,其它伴发畸形包括继发孔房间隔缺损、主动脉瓣单瓣或两瓣畸形、主动脉瓣下狭窄。超声心动图明确诊断10例,提示IAA或重度缩窄8例,未提示主动脉弓病变3例,漏诊率为14·3%。21例中3例超声心动图诊断比较明确且患儿心功能差,未做心导管检查直接手术治疗,术中发现与超声心动图一致;9例施行手术治疗;2例分期手术均为年长儿,手术效果理想;余7例施行一期根治术(6例为3个月以下婴儿,1例为5岁男孩),其中4例手术顺利,术后恢复好,3例围手术期死亡,死亡原因分别为术后室颤、鱼精蛋白过敏和术后严重肺炎呼吸衰竭。结论超声心动图为初步诊断IAA的重要方法,但有一定漏诊率,确诊宜结合心导管检查及心血管造影;婴儿期治疗采取一期根治术,病死率仍较高,围手术期并发症是导致死亡主要原因。 Objective To analyze the incidence of aortic arch disconnection (IAA) and summarize the diagnosis and treatment experience. Methods The clinical data of 21 cases of IAA admitted to Children’s Hospital of Fudan University from 1995 to 2004 were retrospectively analyzed. Results 21 cases of IAA children aged 12 to 11 years (median 1.5 months), 11 males and 10 females. Accounting for 0.1% of children with congenital heart disease over the same period. There were 18 cases (85.7%) of type A, 3 cases of type B (14.3%), and no type C cases. All cases were complicated with patent ductus arteriosus and large ventricular septal defect, and other associated deformities, including secondary atrial septal defect, aortic valve or two deformities, aortic stenosis. Echocardiography confirmed the diagnosis of 10 cases, suggesting that IAA or severe narrowing in 8 cases, did not prompt the aortic arch lesions in 3 cases, the missed diagnosis rate was 14.3%. 21 cases, 3 cases of echocardiography diagnosis is relatively clear and children with poor cardiac function, cardiac catheterization did not do direct surgery, intraoperative findings and echocardiography; 9 cases underwent surgery; 2 cases were staged surgery were elderly In the remaining 7 cases, radical operation was performed in 7 cases (6 infants less than 3 months old and 1 case 5 years old boy). Of the 4 cases, the operation was successful and the postoperative recovery was good. Three patients died perioperatively, Causes of death were postoperative ventricular fibrillation, protamine allergy and postoperative severe pneumonia respiratory failure. Conclusion Echocardiography is an important method for the preliminary diagnosis of IAA. However, there is a certain misdiagnosis rate. Cardiac catheterization and cardiovascular angiography should be combined in the diagnosis. Infant treatment should be one-stage radical operation with high mortality and perioperative complications The main cause of death.
其他文献
目的探讨肝癌p33ING1bmRNA表达水平及与临床病理特征的关系,揭示p33ING1b基因在肝癌发生发展中的作用及临床诊断意义。方法用逆转录聚合酶链反应(RT-PCR)检测55例原发性肝癌
介绍了我国太阳能热水器建筑一体化发展的背景及历史沿革;论述了国内在太阳能热水器与建筑一体化方面的研究现状,并分析了国内太阳能热水器与建筑一体化的发展动向及其市场前
目的探讨心率与多层螺旋 CT(MSCT)冠状动脉(简称冠脉)成像运动伪影的关系,及MSCT 冠脉成像的临床应用价值。方法对200例临床拟诊冠心病的患者行 MSCT 冠脉成像检查,分析扫描
目的评价多层螺旋 CT(MSCT)在小儿川崎病冠状动脉损害中应用的可行性及价值。方法 34例川崎病患儿进行16层或64层 CT 冠状动脉增强扫描,其中18例有同期二维超声心动图检查对
目的:探讨一氧化氮/L-精氨酸(NO/L-Arg)系统和尾加压素Ⅱ(U Ⅱ)在大鼠慢性缺氧(O2)高二氧化碳(CO2)肺动脉高压病理过程的作用及关系.方法:40只大鼠随机分成4组(每组各10只):
随着城市建设不断增多,外墙面砖在外墙装饰使用频率不断增加,它的装饰质量也越来越引起人们的注意.笔者根据多年的施工经脸,根据新疆的气候和环境的特点,针对产生外墙面砖出
在广西山区送电线路中使用人工挖孔桩基础,不仅适应广西山区地形、经济性指标好、承载能力较大、基础开挖量少,而且更加环保节能.
结合工程实例按照支架、模板、钢筋、混凝土、钢绞线、张拉、压浆及封锚等施工工艺对后张法预应力施工质量控制进行论述.
本文阐述了沥青混合料路面产生凹凸的原因,并分析其中的不利影响和提出了有效的防治措施.
目的:测定神经肌肉接头处乙酰胆碱受体分子五聚体中亚基的表达,判断脊髓空洞源性脊柱侧凸患者椎旁肌是否存在失神经支配.方法:将2003年3月~2004年10月行手术治疗的40例患者分