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Objective@#To analyze the clinical effect of right subaxillary small incision approach on children with congenital heart disease (CHD).@*Methods@#Eighty-six patients with CHD admitted to Henan Children′s Hospital from January 2015 to September 2017 were enrolled in this study.The patients were randomly divided into the control group and the observation group with 43 cases each group.The control group underwent sternal median incision, and the observation group underwent right subaxillary small incision.The total effective rate, incision satisfaction, general conditions of surgery (cardiopulmonary bypass time, operation time, aortic occlusion time, intraoperative blood loss), postoperative related conditions (thoracic drainage volume, postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, hospitalization expenses), Wong-Baker facial expression scale (FPS-R) score, as well as the respiratory function index including the levels of peak inspiratory pressure (PIP) and alveolar-arterial oxygen pressure difference [p(A-a) (O2)]after anesthesia (T1), after operation (T2), at admission to intensive care unit (T3) and before extubation (T4) and complication rate between 2 groups were compared.@*Results@#(1)The incision satisfaction in the observation group [90.70% (39/43 cases)] was higher than that in the control group [62.79% (27/43 cases)], and the difference was statistically significant (χ2=9.382, P=0.002). (2)There was no significant difference in the the extracorporeal circulation time, operation time and aortic block time between the two groups [observation group: (68.94±8.26) min, (2.33±0.21) h, (28.79±7.32) min; control group: (67.11±9.11) min, (2.25±0.31) h, (30.02±6.88) min] (P>0.05). (3)The intraoperative blood loss [(89.87±11.25) mL] in the observation group was less than that in the control group [(105.91±31.01) mL], which difference was statistically significant (t=3.189, P=0.002). (4)Also there was significant difference in postoperative monitoring time, postoperative assisted ventilation time, hospitalization time, thoracic drainage volume and hospitalization expenses between the two groups (the observation group: postoperative monitoring time (30.55±10.39) h, postoperative assisted ventilation time [(9.68±2.19) h, hospitalization time (9.61±2.17) d, thoracic drainage volume (90.36±26.14) mL, hospitalization expenses (36 956.15±1 097.84) yuan; the control group: (41.39±9.93) h, (12.72±3.81) h, (12.33±3.15) d, (163.24±29.36) mL and (45 271.97±1 134.55) yuan] (t=4.946, 4.536, 4.663, 12.157, 34.540, all P<0.01). (5)FPS-R scores at 1, 2, 3, 4 d postoperatively in the observation group were (4.02±0.41), (3.41±0.15), (2.55 ±0.20) and (1.16±0.27) points, while those in the control group were respectively (5.21±0.89), (5.02±0.63), (4.12±0.67) and (3.05±0.39) points, which differences were statistically significant (t=7.963, 16.302, 14.724, 26.128, all P<0.01). (6)There was no significant difference in p(A-a) (O2) and PIP between the two groups at T1, T2, T3 and T4 (all P>0.05). There was no significant difference in the complication rate between the observation group [6.98% (3/43 cases)] and the control group [4.65% (2/43 cases)] (χ2=0.000, P>0.05).@*Conclusions@#Right subaxillary small incision approach does not affect the respiratory function of children with CHD, which can improve the satisfaction of incision, reduce the amount of blood loss, accelerate postoperative recovery of children, relieve postoperative pain, and reduce the financial burden of parents.Besides, intra-operative proficient and accurate operations can reduce or avoid the occurrence of related complications and ensure the safety of surgery.
ABSTRACT
Objective To analyze the clinical effect of right subaxillary small incision approach on children with congenital heart disease (CHD).Methods Eighty-six patients with CHD admitted to Henan Children's Hospital from January 2015 to September 2017 were enrolled in this study.The patients were randomly divided into the control group and the observation group with 43 cases each group.The control group underwent sternal median incision,and the observation group underwent right subaxillary small incision.The total effective rate,incision satisfaction,general conditions of surgery (cardiopulmonary bypass time,operation time,aortic occlusion time,intraoperative blood loss),postoperative related conditions (thoracic drainage volume,postoperative monitoring time,postoperative assisted ventilation time,hospitalization time,hospitalization expenses),Wong-Baker facial expression scale (FPS-R) score,as well as the respiratory function index including the levels of peak inspiratory pressure (PIP) and alveolar-arterial oxygen pressure difference [P(A-a) (O2)] after anesthesia (T1),after operation (T2),at admission to intensive care unit (T3) and before extubation (T4) and complication rate between 2 groups were compared.Results (1) The incision satisfaction in the observation group [90.70％ (39/43 cases)] was higher than that in the control group [62.79％ (27/43 cases)],and the difference was statistically significant (x2 =9.382,P =0.002).(2) There was no significant difference in the the extracorporeal circulation time,operation time and aortic block time between the two groups [observation group:(68.94 ± 8.26) min,(2.33 ± 0.21) h,(28.79 ± 7.32) min;control group:(67.11 ± 9.11) min,(2.25 ± 0.31) h,(30.02 ± 6.88) min] (P ＞ 0.05).(3) The intraoperative blood loss [(89.87 ± 11.25) mL]in the observation group was less than that in the control group [(105.91 ± 31.01) mL],which difference was statistically significant (t =3.189,P =0.002).(4)Also there was significant difference in postoperative monitoring time,postoperative assisted ventilation time,hospitalization time,thoracic drainage volume and hospitalization expenses between the two groups (the observation group:postoperative monitoring time (30.55 ± 10.39) h,postoperative assisted ventilation time [(9.68 ± 2.19) h,hospitalization time (9.61 ± 2.17) d,thoracic drainage volume (90.36 ±26.14) mL,hospitalization expenses (36 956.15 ± 1 097.84) yuan;the control group:(41.39 ± 9.93) h,(12.72 ± 3.81)h,(12.33 ± 3.15) d,(163.24 ± 29.36) mL and (45 271.97 ± 1 134.55) yuan] (t =4.946,4.536,4.663,12.157,34.540,all P ＜ 0.01).(5)FPS-R scores at 1,2,3,4 d postoperatively in the observation group were (4.02 ± 0.41),(3.41 ± 0.15),(2.55 ± 0.20) and (1.16 ± 0.27) points,while those in the control group were respectively (5.21 ±0.89),(5.02 ± 0.63),(4.12 ± 0.67) and (3.05 ± 0.39) points,which differences were statistically significant (t =7.963,16.302,14.724,26.128,all P ＜ 0.01).(6)There was no significant difference in P(A-a) (O2) and PIP between the two groups at T1,T2,T3 and T4 (all P ＞ 0.05).There was no significant difference in the complication rate between the observation group [6.98％ (3/43 cases)] and the control group [4.65％ (2/43 cases)] (x2 =0.000,P ＞ 0.05).Conclusions Right subaxillary small incision approach does not affect the respiratory function of children with CHD,which can improve the satisfaction of incision,reduce the amount of blood loss,accelerate postoperative recovery of children,relieve postoperative pain,and reduce the financial burden of parents.Besides,intra-operative proficient and accurate operations can reduce or avoid the occurrence of related complications and ensure the safety of surgery.
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Objective To compare the efficacy of arterial stenting with that of traditional B -T shunt for neo-natal pulmonary atresia with intact ventricular septum.Methods Twenty -six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 201 5,aged 3 to 23 days[(8.20 ±4.80)days],and weighted 2.80 -3.88 (3.41 ±0.27)kg.Accompanied with pulmonary hypo-plasia,all these patients were combined with PDA and ASD or PFO.Before operation,the peripheral oxygen saturation was kept in 61 % -75%,averaged at 67%.Among them,1 2 cases underwent arterial catheter stenting,and 1 4 cases re-ceived B -T shunt (including modified B -T shunt and central shunt)ductus ligation.After operation,the oxygen satu-ration in these children was observed,and they were examined by echocardiography and true lateral chest X -ray,blood flow situations in stents and shunts were assessed,and follow -up examinations were conducted in 1 ,3,6 and 1 2 months postoperatively.Results Stents were successfully inserted into these 1 2 cases.After traditional pulmonary shunt,pa-tients′peripheral oxygen saturation was (82.73 ±5.59)%,compared with that of patients after arterial catheter sten-ting (86.1 8 ±3.1 9)%,there was significant difference(t =1 0.71 ,P <0.05).In pulmonary shunt group,2 cases died,1 case died of postoperative heart failure,and the other case was complicated with pulmonary infection and died of respiratory failure;in catheter stent group,1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow -up examinations 1 ,3,6 and 1 2 months after the operation,1 case of B -T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow,less shunt volume,and ox-ygen saturation decreased to 69%.For the catheter stent group,1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively,and after the operation,transcutaneous oxygen saturation was improved.No patients died in the catheter stent group.Conclusions In traditional B -T shunts,the operation is extensive,and complications are common,and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one -stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively.
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Objective To investigate the merit and feasibility of vasoactive drugs by the double atrial infusion in children with congenital heart disease combined with pulmonary hypertension.Methods Ninety cases of congenital heart disease combined with pulmonary hypertension were randomly selected.One group(45 cases) was infused by double atrialadministration,which left atrium for catecholamines,and right atrial infusion for highly targeted expansion of pulmonary vascular drugs,such as prostaglandin E1.Another group(45 cases) was infused through the right atrium by a central venous to catecholamines and pulmonary vascular dilatation drugs.Cardiac output(CO) and cardiac index were measured by thermal dilution method and systemic vascular resistance and pulmonary vascular resistance(PVR) were calculated.Results Three cases were dead in early postoperative period(1 week),which were central intravenous group.2 cases with total anomalous pulmonary venous drainage had low co after operation,include 1 case through the left atrium,and the other case through central venous administration,and were recovered.There was no long-term mortality.There was no significant difference in CPB time,blocking time,the amount and timing of vasoactive drugs in two groups (P ＞ 0.05).Conclusion Double atrial infusion of vasoactive drugs can significantly reduce the mean pulmonary artery pressure and pulmonary vascular resistance,and increase CO,which is better than the traditional central intravenous methods.The treatment method is of very important significance.Thus double atrial infusion is safe and feasible.
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Objective To explore the surgical diagnosis of pediatric empyema, treatment and surgical operation opportunity. Methods From July 2003 to March 2009, 55 cases were treated , and plcural effusion was punctured in 2 cases. Closed drainage of thoracic cavitythe was done under local anesthesia in rest cases. 21 case fully recovered and 32 cases were taken pleural decortication. One case was taken pleural decortication and thoracoplasty. Results There was no operative mortality. After follow - up of 3 to 24 months, there was no recurrence , no complications such as thoracic deformity. Conclusion Pediatric empyema need timely diagnosis and active conservative treatment. Once fluidify absorbed slowly and there was persistent tendency, operation need to be done as soon as possible. After pleural decortication, we can get satisfied therapeutic effect.