Objective To study the feasibility, indication, technique of emergency operation and the perioperative management on critical congenital heart disease in infants. Methods From May 1998 to May 2003, 67 emergency operations of critical congenital heart disease were performed in infants . The age was 14d-32 months (mean , 11.8±8.9 months), the weight was 2.6-14.8 kg( mean, 8.4±3.0 kg). The diagnosis included ventricular septal defect in 39, tetralogy of Fallot in 13, complete atrioventricular septal defect in 5, total anomalous pulmonary venous drainage in 4, atrial septal defect with pulmonary valve stenosis in 3, D-transposition of the great arteries in 2, and postoperative pulmonary valve vegetation in 1. Corrective operation in 64 and palliative operation in 3 were done. Results The preoperative managing time was 0-9 d(mean , 3.7±2.6 d), the lasting time of intubation was 1-14d( mean, 3.8±3.2 d), and ICU staying time was 2-18 d (mean, 5.7±2.8 d). The operative mortality was 7.5% (5/67), the postoperative complications in other infants include 14 low cardiac output syndrome, 14 atelectasis, 8 lung infection, 2 worsened pulmonary hypertension, 1 pneumothorax , and 1 phrenic nerve paralysis. Following up 2-60 months with 1 case late death, the cardiac function of the others were class Ⅰ-Ⅱ/Ⅵ, the operative result was satisfactory. Conclusions The emergency operation on critical congenital heart disease in infants is safe, and can save most of their lives, the good result can be obtained from surgical treatment. Accurate choice of indications, and perioperative good nutritional and cardiorespiratory function support are important.
ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.
ObjectiveTo investigate the clinical effectiveness of early repair in infants with large ventricular septal defect complicated with pneumonia. MethodsWe retrospectively analyzed the clinical data of 30 infants who underwent emergency operation in our hospital between January 2014 and April 2015. There were 16 males and 14 females at age of 0.9-12.0 (4.6±2.9) months and with weight of 3.0-8.8 (5.6±1.4) kg. They were diagnosed as ventricular septal defect combined with pneumonia as a trial group. There were other 30 patients without pneumonia, 10 males and 20 females, aged of 0.7-19.0 (4.9±4.8) months, weighing 2.6-12 (5.8±2.1) kg, as a control group. All the patients were followed up for 6 months. ResultsOne patient died in the trial group. None died in the control group. There were statistical differences in length of hospital stay (15.73±6.44 d vs. 10.16±2.16 d, P=0.002) and mechanical ventilation time (28.00±15.72 h vs.12.17±9.10 h, P=0.000) between the trial group and the control group. There was no statistical difference in aortic cross-clamping time, cardiopulmonary bypass time, or CICU residence time (P > 0.05). All the patients were followed up for 6 months. Incidence of pneumonia reduced, growth status and exercise tolerance significantly improved. ConclusionEmergency operation for the infants who suffered from ventricular septal defect with severe pneumonia is efficient and effective. Early mechanical ventilation may be beneficial to the procedure.