婴幼儿先天性心脏病合并重症肺炎的治疗

Treatment of congenital heart disease complicated by severe bronchopneumonia in infants

摘要:

目的：探讨婴幼儿先天性心脏病合并重症肺炎并心力衰竭的治疗及转归。方法：收集2007年1~12 月我院PICU 病房收治的先天性心脏病（左向右分流型）合并重症肺炎并心力衰竭患儿24 例, 对其治疗方法和转归等资料进行分析。结果：痊愈22 例, 死亡2 例。其中6例<6个月婴幼儿合并重症肺炎反复迁延不愈，反复出现心衰,在机械通气和气管插管条件下行体外循环、心内直视手术矫正心脏畸形，痊愈出院。其他18例患儿经积极抗感染及控制心衰治疗后，重症肺炎得到控制，心衰缓解而择期手术，其中16例痊愈，2例因并发低心排综合征、弥散性血管内凝血死亡。结论：婴幼儿先天性心脏病合并重症肺炎，在内科保守治疗效果不佳时应尽早进行手术治疗，以降低婴幼儿先天性心脏病的病死率。［中国当代儿科杂志，2009，11（8）：635-637］

Abstract:

OBJECTIVE: To study the treatment and the treatment outcome in infants with congenital heart disease complicated by severe pneumonia and heart failure. METHODS: The clinical data of 24 infants with congenital heart disease (left to right shunt) complicated by severe pneumonia and heart failure between January 2007 and December 2007 were retrospectively reviewed. RESULTS: Twenty-two infants recovered and 2 died. Severe pneumonia and heart failure were refractory even after 1-2 months medical treatment in 6 infants at ages of <6 months. They then underwent an open heart surgery under the mechanical ventilation and tracheal intubations and were successfully cured. The other 18 infants underwent a selective heart surgery after pneumonia and heart failure had been improved. Sixteen infants were successfully cured and 2 died of postoperative low cardiac output syndrome and diffuse intravascular clotting. CONCLUSIONS: The heart surgery should be performed early when the medical treatment does not work in infants with congenital heart disease complicated by severe pneumonia and heart failure. This may improve their outcome.［Chin J Contemp Pediatr, 2009, 11 (8):635-637］