Burrows F A, Williams W G, Teoh K H, Wood A E, Burns J, Edmonds J, Barker G A, Trusler G A, Weisel R D
Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1988 Oct;96(4):548-56.
The hemodynamic response to increasing left atrial pressure by volume loading was evaluated in 70 children during the first 24 hours after repair of congenital cardiac defects. The children were grouped into four diagnostic categories: atrial septal defect or pulmonary valve stenosis (n = 8), ventricular septal defect (n = 36), complete transposition after Mustard's operation (n = 13), and tetralogy of Fallot (n = 13). Within 2 hours of bypass, both cardiac index and left ventricular stroke work index were adequate and increased appropriately with volume loading in all four diagnostic groups. The atrial septal defect group demonstrated a similar response to volume loading 4 and 24 hours after bypass. However, the other three diagnostic groups had a higher filling pressure, lower cardiac index and stroke work index, and a depressed response to increasing preload 4 hours postoperatively, which indicated a deterioration in cardiac performance. The deterioration was maximal between 4 and 12 hours after bypass, and performance tended to recover 24 hours postoperatively. The transposition group had a more profound depression in cardiac performance than the other two groups. Within the ventricular septal defect group, smaller children (body surface area less than 0.36 m2) had a more profound depression in performance than larger children. These results demonstrate a significant alteration in cardiac performance during the first 24 hours after repair of congenital cardiac defects in children. These changes should be considered when postoperative management is being planned.
在70名先天性心脏缺陷修复术后的儿童中，于术后头24小时内评估了容量负荷增加导致左心房压力升高时的血流动力学反应。这些儿童被分为四个诊断类别：房间隔缺损或肺动脉瓣狭窄（n = 8）、室间隔缺损（n = 36）、Mustard手术后的完全性大动脉转位（n = 13）以及法洛四联症（n = 13）。在体外循环后2小时内，所有四个诊断组的心脏指数和左心室每搏功指数均充足，并随着容量负荷的增加而适当升高。房间隔缺损组在体外循环后4小时和24小时对容量负荷表现出类似的反应。然而，其他三个诊断组在术后4小时有较高的充盈压、较低的心脏指数和每搏功指数，以及对增加前负荷的反应减弱，这表明心脏功能恶化。这种恶化在体外循环后4至12小时最为明显，术后24小时心脏功能倾向于恢复。大动脉转位组的心脏功能抑制比其他两组更严重。在室间隔缺损组中，较小的儿童（体表面积小于0.36平方米）的心脏功能抑制比较大的儿童更严重。这些结果表明，儿童先天性心脏缺陷修复术后头24小时内心脏功能有显著改变。在规划术后管理时应考虑这些变化。
