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目的:探讨婴幼儿法洛四联症(tetralogy of Fallot,TOF)矫治术后,毛细血管渗透症发病机制、诊断及处理。方法:我院2005年3月至2010年1月施行婴幼儿TOF矫治术161例,术后并发毛细血管渗透症6例,男性4例,女性2例,年龄9~36个月,平均(8±0.6)个月;体质量8.5~15.5kg,平均(8.2±2.10)kg。全组均及时给予提高胶体渗透压、应用血管活性药、腹膜透析、呼吸机辅助维持呼吸、循环稳定和组织灌注治疗。结果:治愈5例,死亡1例,死于肾、肺、心多脏器衰竭。结论:婴幼儿心脏术后毛细血管渗透症发病机制与补体致炎性介质释放,使毛细血管通透性增加有关,低心排出量综合征(低心排)、呼吸衰竭、急性肾衰竭、脑损害是致死主要原因,及时采用腹膜透析和免疫球蛋白可获得较好疗效。
Objective: To investigate the pathogenesis, diagnosis and treatment of capillary osmosis after infantile tetralogy of Fallot (TOF) correction. Methods: From March 2005 to January 2010, 161 infants and children with TOF correction were treated in our hospital. There were 6 cases of postoperative capillary osmosis, 4 males and 2 females, ranging in age from 9 to 36 months (average, 8 ± 0.6) months; body weight 8.5 ~ 15.5kg, mean (8.2 ± 2.10) kg. The whole group were promptly given to improve the colloid osmotic pressure, the application of vasoactive drugs, peritoneal dialysis, ventilator-assisted maintenance of breathing, circulation stability and tissue perfusion therapy. Results: 5 cases were cured, 1 died, died of multiple organ failure of kidney, lung and heart. CONCLUSIONS: The pathogenesis of capillary osmosis in infants and young children is related to the release of inflammatory mediators from complement causing the increase of capillary permeability. Low cardiac output syndrome (low cardiac output), respiratory failure, acute renal failure, brain Damage is the main cause of death, the timely use of peritoneal dialysis and immunoglobulin can obtain better efficacy.