埃塞俄比亚儿科心脏外科学：发展中国家单中心经验。

Pediatric Cardiac Surgery in Ethiopia: A Single Center Experience in a Developing Country.

机构信息

Children's Cardiac Center of Ethiopia.

Department of Internal Medicine, Jimma University, Jimma, Ethiopia.

出版信息

Ethiop J Health Sci. 2023 Jan;33(1):73-80. doi: 10.4314/ejhs.v33i1.10.

DOI:10.4314/ejhs.v33i1.10

PMID:36890940

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9987286/

Abstract

BACKGROUND

In developing countries, the diagnosis of congenital heart diseases (CHD) is growing as the availability of echocardiography is increasing with most diagnoses made after birth. However, the access to pediatric surgery is still low and is mainly done by global surgical campaigns rather than local surgeons. Ethiopia has trained its local surgeons, and this is expected to improve the care of children with CHD. We aimed to evaluate the experience of local pediatric CHD surgery and its outcome in a single-center in Ethiopia.

METHODS

A hospital-based retrospective cohort study was done by including all patients with CHD and acquired heart disease in patients under the age of 18 operated at children's cardiac center in Addis Ababa Ethiopia. We set in-hospital mortality, 30-day mortality, and the prevalence of complications including major complications after cardiac surgery as the primary outcomes.

RESULTS

A total of 76 children were operated. The mean age at the time of diagnosis and surgery was 4 (±5) and 7 (±5) years, respectively. Forty-one (54%) were female. Ninety five percent of the 76 operated children were with the diagnoses of congenital heart diseases while the rest (5%) with acquired heart disease. Of those with congenital heart disease, Patent ductus arteriosus (PDA) accounted for (33.3%), Ventricular septal defect (VSD) for 29.5% and Atrial Septal Defect (ASD) for 10% and Tetralogy of Fallot (TOF) for 5%. According to the RACS-1 category, 26 (35.1%) were in category 1, 33 (44.6%) were in category 2, 15 (20.3%) were in category 3 and none of the children were in category 4 and 5. In-hospital mortality was 2.6% whereas there was no patient who died within 30 days after discharge. Operative mortality was 2.6%.

CONCLUSIONS

Various types of lesions were treated in the hands of the local teams with VSD and PDA ligations as the commonest of all. The 30day mortality was within acceptable range and this outcome shows congenital and acquired heart diseases can be operated on in developing countries with good outcome despite the limited resources.

摘要

背景

在发展中国家，随着超声心动图的普及，先天性心脏病（CHD）的诊断数量不断增加，大多数诊断都是在出生后做出的。然而，儿科手术的可及性仍然很低，主要是通过全球外科手术活动来完成，而不是由当地外科医生来完成。埃塞俄比亚已经培训了当地的外科医生，这有望改善 CHD 患儿的治疗效果。我们旨在评估埃塞俄比亚一家单中心的本地儿科 CHD 手术经验及其结果。

方法

这是一项以医院为基础的回顾性队列研究，纳入了在埃塞俄比亚首都亚的斯亚贝巴儿童心脏中心接受手术的所有年龄在 18 岁以下的 CHD 和后天性心脏病患者。我们将院内死亡率、30 天死亡率以及心脏手术后主要并发症等并发症的发生率作为主要结局。

结果

共有 76 名儿童接受了手术。确诊和手术时的平均年龄分别为 4（±5）岁和 7（±5）岁。41 名（54%）为女性。76 名接受手术的儿童中，95%被诊断为先天性心脏病，其余（5%）为后天性心脏病。在先天性心脏病中，动脉导管未闭（PDA）占 33.3%，室间隔缺损（VSD）占 29.5%，房间隔缺损（ASD）占 10%，法洛四联症（TOF）占 5%。根据 RACS-1 分类，26 例（35.1%）为 1 类，33 例（44.6%）为 2 类，15 例（20.3%）为 3 类，无 4 类和 5 类患儿。院内死亡率为 2.6%，出院后 30 天内无患者死亡。手术死亡率为 2.6%。