RESUMO
Objective To investigate the therapeutic efficacy of somatostatin on chylothorax after congenital heart disease surgery in children.Methods Retrospective analysis was performed in 13 postoperative chylothorax cases from Jan.2003 to Dec.2012,who were divided into control group (n =6) and treatment group (n =7),and there was no significant difference in age,weight,and time of occurrence between the 2 groups.The diagnosis standard for chylothorax was the same.The changes of chylous volume during the treatment were analyzed between 2 groups,and healing time and other data were analyzed too.Results Control group:clinical cure in 3 cases,conservative treatment failed in 3 cases(2 cases recovered after operation and 1 case died).The chyle volume of control group reduced obviously compared with post treatment from beginning [(256.6 ± 124.2) mL/d] to 1 week [(155.5 ± 85.7) mL/d] and 2 weeks [(142.3 ± 110.3) mL/d] later(t =4.623,2.099 ; P =0.002,0.044).But it did not reduce obviously in 3 weeks later[(139.4 ± 113.4) mL/d] (t =1.745,P =0.07).Treatment group:6 cases in treatment group were successful in recovery after conservative treatment and 1 case underwent operation.The chyle volume of treatment group reduced obviously compared with post treatment from beginning to 1 week [(51.2 ± 18.7) mL/d] and 2 weeks [(19.3 ± 7.05) mL/d] later (t =5.549,6.638 ;P =0.001,0.001).Compared with the control group,the difference between 2 groups in post treatment (1 week later,2 weeks hater) was of statistical significance (t =2.900,2.412 ; P =0.014,0.034).The healing time of conservative treatment in 2 groups (only for recovery) had obvious difference [(32.8 ± 1.8) d,(25.2 ± 1.7) d] (t =2.512,P =0.028).Conclusions The use of somatostatin can significantly promote the recovery of chylothorax in children,and it should be actively used in early conservative treatment.
RESUMO
Objective To investigate pathogen bacteria distribution and clinical analysis of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery for guiding the rational clinical use of antimicrobial drugs.Methods The clinical data of ventilator-associated pneumonia in infants and young children with congenital heart disease after surgery were retrospectively analyzed for microbiologically documented infection.Bacterial identification was performed in an automatic VITEK2Jr expression system and antimicrobial susceptibility testing by Kirby2Bauer method.The results of antimicrobial susceptibility testing were performed in WHONET 5.0 system software.Results There were 16 strains of pathogenic bacteria in 2010,Gram-negative bacteria 9 stains (Klebsiella pneumoniae 18.75％,Acinetobacter baummannii 12.5％),gram positive coccus 6strains (Streptococcus 18.75％),Fungi 1 strain.There were 32 strains of pathogenic bacteria in 2011,Gram-negative bacteria 24 stains (Acinetobacter baummannii 31.25％,Klebsiella pneumoniae 25％,Pseudomonas aeruginosa 6.25％),gram positive coccus 8 strains (Enterococcus 12.5％,Streptococcus 6.25％).There were 42 strains of pathogenic bacteria in 2012,Gram-negative bacteria 38 stains (Acinetobacter baummannii 26.19％,Klebsiella pneumoniae33.33％,Pseudomonas aeruginosa 21.42％),gram positive coccus 4 strains (Enterococcus 4.76％).Acinetobacter baummannii remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Meropenem,Imipenem,Klebsiella pneumonia remained highly sensitive to Amikacin and Levofloxacin,highly resistant to Cefoperazone/Sulbactam,Meropenem,Imipenem,trimethoprim-sulfamethoxazole,Ciprofloxacin.Pseudomonas aeruginosa only remained sensitive to Levofloxacin and Piperacillin/Tazobactam.Gram-positive cooci proportion in pathogenic bacteria decreased year by year,Streptococcus and Enterococcus had major proportion in Gram-positive cooci,Staphylococci decreased,There was no Staphylococcus,Enterococcus and Staphylococci resistant to vancomycin.Conclusions Gram-negative bacteria was the major pathogenic bacteria in ventilator-associated pneumonia with congenital heart disease postoperative infants and young children,Acinetobacter baummannii Klebsiella pneumoniaeand Pseudomonas aeruginosa had major proportion in gram-negative bacteria and drug resistance increased.Rational use of antibacterials was very important to reduce drug resistant strains.