Clinical Study Of Postoperative Respiratory Management And Circulatory Support For Congenital Heart Disease

Objective:To evaluate the diagnosis,therapy results and prognosis of congenital heart disease associated with congenital tracheal stenosis in infants,providing a basis for the diagnosis and treatment of these diseases.Methods:We retrospectively reviewed the medical record of 86 children with CTS from Jan.2013 to Dec.2015 We set the inclusion criteria and exclusion criteria,collect children with preoperative,intraoperative and postoperative clinical data,All children underwent X-ray,echocardiography,spiral computed tomography examination and bronchoscopy study.Early extubation strategy were used for upper CTS,whereas for the lower CTS,we should taking into account the heart-lung function and the airway management in the meantime.Results:In children with a total of 86 cases,45 cases of male,female 41,age 21.69±20.48 months,weight when the operation 8.91±4.55 kg,length of stenosis 2.81±1.20 cm,extracorporeal circulation time is 91.65±21.02 min,aorta blocking time 59.19±19.59 min,mechanical ventilation 121.49±91.32 hours time,ICU stay time 9.21±5.56 days,pneumonia 37 cases,17%of the total,including 5 cases of death,accounting for 5.8%.24 cases with upper CTS and 62 cases with lower CTS,comparison between the two groups preoperative,intraoperative and postoperative data,age and weight before operation had no significant difference.But mechanical ventilation time,ICU retention time between the two groups,there were significant differences.Conclusion:The common presentation of congenital heart disease associated with congenital tracheal stenosis in infants are tachypnea,stridor,and dyspnea.Flexible bronchoscope and multi-slices spiral computed tomography is an important imaging modality.Conservative treatment was safe and feasible for the majority of CHD patients with CTS.But for the long segment CTS,surgery or stent were recommended for the ventilator-dependent patients.Objective:To analyze and discuss the curative effect and adverse reactions of bronchoalveolar lavage in the treatment of patients with refractory pneumonia.Methods:118 patients with refractory pneumonia and pneumonia absorbed slowly were selected from Jenuary 2013 to December 2015,and they were randomly divided into the observation group(58 cases)and the control group(58 cases).The control group was treated with conventional therapy,and the observation group was additionally given bronchoalveolar lavage.The clinical outcomes,adverse reactions,blood gas analysis and changes in CRP were observed and compared between the two groups.Results:After the treatment,the total eficiency of the observation was 90.6%,which was significantly higher than that of the control group(70.3%)(P<0.05).Blood gas analysis and CRP all improved significantly after the treatment(P<0.05),and the improvement was more pronounced in the observation group than in the control group(P<0.05).There Was no serious adverse reactions occurred in the two groups.Conclusion:Bronchoalveolar lavage has significant curative effect and high safety in the treatment of patients with refractory pneumonia.Objective:The purpose of our research was to study the clinical outcomes of children with congenital heart disease(CHD)requiring extracorporeal membrane oxygenation(ECMO)support after cardiac surgery at Fu Wai hospital and to get a better result.Methods:We retrospectively reviewed the medical record of 31 children requiring ECMO support from January 2012 to June 2015.The indications for the use of ECMO included Ventricular contraction weakness or repeatedly ventricular fibrillation and difficult to wean from cardiopulmonary bypass in the operating room;and appearing serious low cardiac output or cardiac arrest in the ICU.All the patients were performed surgery under extracorporeal circulation,and the ECMO was performed by the method of thoracic intubation.Results:Patients age ranged from 53 day to 8 years and body weight ranged from 4.3 to 28.3kg.The duration time of ECMO was 70?355(146.48±66.82)hours,22 children(71.0%)were successfully weaned and 15(48.4%)survived to discharge.There were acute kidney injury,neurological complications,infection,bleeding and hemolysis.Conclusion:The overall treatment outcomes depends on the selection of indication and the complications during ECMO.