网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
跨区域、跨海拔远程输送及诊治先天性心脏病患儿:疗效及并发症观察研究
作者:胡晓虹1  郭晓峰2  吉炜3  黄娟2 
单位:1. 上海交通大学医学院附属新华医院 心内科, 上海 200092;
2. 福建省儿童医院 心内科, 福建 福州 350001;
3. 上海交通大学医学院附属上海儿童医学中心 心内科, 上海 200127
关键词:先天性心脏病 西藏 高原 诊疗模式 医疗援助 
分类号:R544.1
出版年·卷·期(页码):2024·52·第二期(248-253)
摘要:

目的:本研究旨在评估跨地理区域、跨海拔气候远程输送及诊疗先天性心脏病患儿模式的可行性及安全性。方法:组建了一支专业团队,前往西藏对3个县区的2 800名儿童进行经胸多普勒超声心动图检查,随后组织了跨越3 000 km的远距离输送,对符合手术指征的患儿进行手术治疗。西藏当地社保和社会慈善机构共同提供诊疗经费支持,手术由上海、福建两地的专家共同主刀,术后观察相关不良事件,复查心电图、经胸超声心动图评估手术效果。结果:共筛选出19例先天性心脏病患儿,中位年龄6岁,男性患儿10例;包括房间隔缺损10例,动脉导管未闭4例,室间隔缺损4例,室间隔缺损合并动脉导管未闭1例;在整个远程和长时间的接送过程中,未发生任何患儿或家属的不良事件。6例房间隔缺损及4例动脉导管未闭患儿进行了介入封堵术治疗,4例房间隔缺损、4例室间隔缺损及1例室间隔缺损合并动脉导管未闭患儿进行了心外科开胸手术。所有患儿术后复查未见残余分流,术后左心室射血分数(LVEF)64.7%±7.1%,与术前LVEF(68.4%±4.6%)比较差异无统计学意义(P>0.05);术后肺动脉压力(28.3±8.3)mmHg,低于术前(37.7±13.4)mmHg(P<0.05)。进行介入治疗的患儿术后心电图PR间期为(130.3±16.3)ms,与术前(126.0±15.2)ms比较差异无统计学意义(P>0.05);术后QRS间期(77.4±7.7)ms与术前(81.6±10.3)ms比较差异无统计学意义(P>0.05)。1例动脉导管未闭患儿在手术后1~2 d出现了短暂的头痛、头晕、血压升高症状,但1周后完全康复。其他患儿在手术后恢复良好,2周后安全返回西藏。结论:由于地区发展差异,某些地区的医疗条件较为薄弱,无法满足当地儿童先心病的诊疗需求。通过将患儿远程输送至经济发展水平较高的地区进行治疗,取得了预期的手术有效性和安全性。

Objective: To evaluate the effectiveness and safety of long-distance transportation and diagnosis and treatment of congenital heart disease in children across geographical regions and altitudes. Methods: A professional team was set up and went to Xizang to examine 2 800 children in three counties and districts with transthoracic Doppler echocardiography, and then organized long-distance transportation across 3 000 km to perform surgical treatment for children who meet the surgical indications. Financial support was provided by the local social security and social charity organizations in Xizang for diagnosis and treatment. Cardiologist from Shanghai and Fujian jointly conducted the operation. After the operation, relevant adverse events were observed, and the operation results were evaluated by rechecking electrocardiogram and color Doppler echocardiography. Results: 19 children with congenital heart disease were selected, with a median age of 6. There were ten male children, and including 10 cases of atrial septal defect, 4 cases of patent ductus arteriosus, 4 cases of ventricular septal defect, and 1 case of ventricular septal defect combined with patent ductus arteriosus. There were no adverse events involving the child or family members during the entire long-distance and long-term transportation process. 6 cases of atrial septal defect and 4 cases of patent ductus arteriosus underwent interventional closure surgery. 4 cases of atrial septal defect, 4 cases of ventricular septal defect, and 1 case of ventricular septal defect combined with patent ductus arteriosus underwent cardiac surgery. All patients postoperative follow-up by echocardiography indicated no residual shunt. The postoperative left ventricular ejection fraction(LVEF) was 64.7%±7.1%, compared to the preoperative LVEF of 68.4%±4.6%,there was no significant difference(P>0.05). The postoperative pulmonary artery pressure was(28.3±8.3)mmHg, which was significantly lower than the preoperative pulmonary artery pressure of(37.7±13.4) mmHg(P<0.05). The postoperative PR interval of children undergoing interventional therapy was(130.3±16.3)ms, compared to the preoperative PR of(126.0±15.2)ms, there was no significant difference(P>0.05). There was no significant difference between the postoperative QRS interval of(77.4±7.7)ms and the preoperative QRS interval of(81.6±10.3)ms(P>0.05).A child with patent ductus arteriosus experienced brief symptoms of headache, dizziness, and elevated blood pressure 1-2 d after surgery but fully recovered one week later. Other children recovered well after surgery and returned to Xizang safely two weeks later. Conclusion: Due to regional development differences, the medical conditions in some areas are relatively weak and cant meet the diagnosis and treatment needs of local children with congenital heart disease. The expected surgical effectiveness and safety have been achieved by transporting the patients over a long distance to areas with higher levels of economic development for treatment.

参考文献:

[1] 李烁琳,顾若漪,黄国英.儿童先天性心脏病流行病学特征[J].中国实用儿科杂志,2017,32(11):871-875.
[2] 马丽媛,王增武,樊静,等.《中国心血管健康与疾病报告2021》要点解读[J].中国全科医学,2022,25(27):3331-3346.
[3] 冯文霄.国内外出生缺陷的流行分布情况[J].中国妇幼保健,2012,27(10):1586-1589.
[4] 强巴措珍,玉珍,樊丽,等.西藏地区先天性心脏病发病率筛查结果研究[J].西藏医药,2021,42(5):58-59.
[5] 王军,王志农,李素芝,等.拉萨市6500名小学生先天性心脏病调查[J].西藏科技,2002(1):12-14.
[6] NIKOLAUS A,HASS,KARL R.SCHIRMER.Guidelines for the management of congenital heart diseases in childhood and adolescence[J].Cardiol Young,2017,27(S3):S1-S105.
[7] 中国医师协会儿科医师分会先天性心脏病专家委员会,中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会.儿童常见先天性心脏病介入治疗专家共识[J].中华儿科杂志,2015,53(1):17-24.
[8] AB MAN S H,HANSMANN G,ARCHER S L,et al.Pediatric pulmonary hypertension:guidelines from the American Heart Association and American Thoracic Society[J].Circulation,2015,132(21):2037-2099.
[9] 高伟,顾红,胡大一,等.2015年先天性心脏病相关性肺动脉高压诊治中国专家共识[J].中国介入心脏病学杂志,2015,23(2):61-69.
[10] 高秉仁,岳凤珍.甘肃省六地市先天性心脏病流行病学调查研究[J].中国循环杂志,2000(5):43-44.
[11] 汪钢.先天性心脏病的诊断进展[J].现代医学,2002,30(5):281-283.
[12] 吴云.我国东中西部经济增长差异与对策分析[J].首席财务官,2020,16(1):50-51.
[13] PAGANO E,FRANK B,JAGGERS J,et al.Alterations in metabolites associated with hypoxemia in neonates and infants with congenital heart disease[J].Congenit Heart Dis,2020,15(4):251-265.
[14] HERBERG U,KNIES R,NICOLE MVLLER,et al.Altitude exposure in pediatric pulmonary hypertension-are we ready for(flight) recommendations?[J].Cardiovasc Diagn Ther,2021,11(4):1122-1136.
[15] 罗绒战堆.生命路上的难关——从农牧民感受小议西藏的平均期望寿命[J].中国藏学,2016(4):112-117.
[16] 乔晓春,胡英.中国老年人健康寿命及其省际差异[J].人口与发展,2017,23(5):2-18.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 749399 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541