Aliku Twalib O, Lubega Sulaiman, Lwabi Peter, Oketcho Michael, Omagino John O, Mwambu Tom
Department of Paediatrics, Gulu University ; Uganda Heart Institute, Mulago Hospital Complex.
Uganda Heart Institute, Mulago Hospital Complex.
Afr Health Sci. 2014 Dec;14(4):946-52. doi: 10.4314/ahs.v14i4.25.
Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI).
We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country.
Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed.
A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2.
Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.
心脏病是一种致残性疾病，许多发展中国家往往缺乏必要的外科干预措施。在国外进行超专科培训主要局限于观察，几乎没有或根本没有实践操作的机会。乌干达心脏研究所（UHI）采用了一种方法，即由来访团队在当地进行心脏直视手术，从而实现技能向当地团队的传授，并有助于培养能力。
我们回顾了乌干达心脏研究所心脏直视手术的进展情况，并评估了在发展中国家进行心脏直视手术的术后结果及面临的挑战。
对2007年10月至2012年6月在乌干达心脏研究所接受心脏直视手术患者的病历进行回顾。
在研究期间，共有124例患者接受了心脏直视手术。最常见的病症为：室间隔缺损（VSD）占34.7%（43/124），房间隔缺损（ASD）占34.7%（43/124），法洛四联症（TOF）占10.5%（13/124）。非政府组织（NGO）为96.8%（120/124）的手术提供了资金，只有4例患者（3.2%）的家属支付了手术费用。所实施手术的复杂性不断增加，从最初主要是房间隔缺损和室间隔缺损，到后来出现了如法洛四联症和完全性肺静脉异位连接（TAPVR）等更复杂的病例。当地团队独立完成了19例手术（15.3%）。术后发病率较低，心律失常、左心室功能障碍和再次手术最为常见。术后脓毒症仅发生2例（1.6%）。总体死亡率为3.2%。
心脏直视手术虽然费用高昂，但在发展中国家是可行的。随着政府和当地慈善机构增加对心脏直视手术的直接资助，更多心脏病患者能够在当地获得手术治疗。
