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目的探讨婴幼儿完全性房室通道(CAVSD)伴肺动脉高压(PAH)患者矫治术后快速康复(fast track,FT)治疗的可行性和安全性。方法自2006年1月至2009年3月阜外心血管病医院小儿心脏外科中心共收治CAVSD矫治术后婴幼儿患者51例,男24例,女27例;年龄4~36个月(12.5±8.9个月)。均按照快速康复临床管理路径行快速康复治疗。分析患者二次气管内插管率,住PICU时间,比较手术前后肺动脉压下降程度。结果 51例患者中有21例(41.17%)行快速康复治疗,均在术后8 h内拔除气管内插管。术后患者平均肺动脉压(MPAP)显著下降(39.59 mm Hg vs.24.50 mm Hg,t=5.514,P<0.05),住PICU时间2.05±0.87 d(18 h~3 d)。1例48 h后因肺部感染二次气管内插管,插管原因与快速康复无关。随访3~6个月,21例患者心功能良好,无二次手术和死亡患者。结论快速康复治疗对部分伴PAH的CAVSD矫治术患者是安全、可行的,能够减少住ICU的天数;但对重度PAH患者的快速康复治疗需要更大样本的研究。
Objective To investigate the feasibility and safety of postoperative fast track (FT) treatment in infants with complete atrioventricular access (CAVSD) and pulmonary hypertension (PAH). Methods From January 2006 to March 2009, 51 children with infantile malnutrition after CAVSD were treated in Fuwai Cardiovascular Hospital Pediatric Cardiac Surgery Center, including 24 males and 27 females, aged from 4 to 36 months (12.5 ± 8.9 months). All were treated according to the path of rapid rehabilitation clinical management. Analysis of patients with secondary endotracheal intubation rate, PICU time, before and after surgery to compare the degree of pulmonary artery pressure drop. Results Twenty-one of 51 patients (41.17%) were treated with rapid rehabilitation. All patients underwent intubation within 8 h after operation. Mean postoperative pulmonary pressure (MPAP) decreased significantly (39.59 mm Hg vs.24.50 mm Hg, t = 5.514, P <0.05), and PICU duration 2.05 ± 0.87 d (18 h to 3 d). One case was infected with the second tracheal intubation after 48 hours because of pulmonary infection. The reason for intubation was not related to rapid rehabilitation. All cases were followed up for 3 to 6 months. Twenty-one patients had good cardiac function without secondary surgery and death. Conclusions Rapid rehabilitation is safe and feasible for some CAH patients with PAH, which can reduce the number of days to live in ICU. However, rapid rehabilitation of patients with severe PAH requires a larger sample.