摘要
目的 探讨新生儿动脉导管未闭 (PDA)并发心力衰竭 (心衰 )急性肺水肿的诊断和抢救措施。 方法 对 14例患儿进行回顾性分析。 结果 彩色多普勒超声心动图 (CDFM )检查 ,PDA管径 2 5～ 3 5mm 4例、3 8～ 7mm 10例。全部合并房间隔缺损 (ASD)继发孔型 ,直径 3～ 10mm。肺动脉收缩压 3 0～ 5 0mmHg 10例、5 0～ 60mmHg 4例。胸片心胸比例 0 63～ 0 64 4例 ,0 65～ 0 7410例 ,均有不同程度肺水肿征象。血气分析PaO2 43～ 60mmHg。 5例广泛肺水肿PaCO2 5 0～ 70mmHg,8例肝脏进行性肿大 >3cm。持续气道正压通气 5例 ,低氧高碳酸血症改善。 11例口服消炎痛 ,5例PDA关闭 ,3例缩小 ,心衰肺水肿随之缓解。无效的 3例口服卡托普利心衰改善 ,分别于 18、2 6、3 8d日龄手术结扎PDA ,另 2例口服卡托普利后心衰缓解 ,分别于 3d和7d行CDFM复查PDA关闭。 1例死亡 ,尸检结果与CDFM和临床诊断吻合。PDA管径 7mm。 结论 CDFM是诊断PDA和估测肺动脉高压、鉴别持续胎儿循环的重要方法 ,胸片有助于判断心源性肺水肿程度和鉴别肺透明膜病、肺炎。动脉血气分析有助于判断病情、指导治疗与观察疗效。口服卡托普利、持续气道正压和尽早手术结扎PDA 。
Objective To explore diagnosis and treatment of PDA newborn complicated with heart failure and acute pulmonary edema.Methods Retrospective analysis was done in 14 cases.Results 4 cases of PDA sizing 2\^5～3\^5mm,10 cases sizing 3\^8～7mm by CDFM.All the cases were complicated with secondary atrial septal defect (ASD).Pulmonary systolic pressures were 30～50 mmHg in 10 cases,50～60 mmHg in 4 cases.Chest films showed heart chest ratios were 0\^63～0\^64 in 4 cases,0\^65～0\^74 in 10 cases.All the cases had pulmonary edema. 8 cases suffered progressive hepatomegaly,5 cases were given continuous positive pressure breathing.Their hypoxia hypercania was remitted quickly.11 cases were given antifan.5 cases of PDA closed, 3 cases got smaller and pulmonary edema lessened.The other 3 cases of PDA were given captopril. Heart function recovered and PDA were closed by operation in 18?26 and 38 day old seperatedly.2 cases were given captopril only,pulmonary edema remitted.PDA were found to be closed in 3～7 days later.1 case died,and autopsy showed PDA was 7 mm,the same size as CDFM.Conclusion CDFM is an important method in diagnosing PDA, evaluating pulmonary hypertension and differentiating persistent fetal circulation.Chest film is helpful to determing degree of cardiac pulmonary edema and differentiating hyaline membrane diseases,pneumonia.Blood gas analysis is useful in determinating clinical condition and observing treating effect.Captopril,continuous positive pressure breathing and surgery as soon as possible are new effective methods in treating PDA in newborn complicated heart failure and pulmonary edema.
出处
《小儿急救医学》
2002年第4期211-213,共3页
Pediatric Emergency Medicine
