Lister G
Yale J Biol Med. 1984 Jan-Feb;57(1):7-27.
The medical management of the child with congenital cardiac disease prior to and following cardiac surgery has made a substantial contribution to the improved morbidity and mortality attributed to surgical advances. This paper provides a framework for understanding the problems that arise in the perioperative period and a systematic approach, by organ system, to monitoring and management of these problems. The discussion is intended to be of general application, focusing on initial stabilization following surgery and the cardiorespiratory, renal, metabolic, hematologic, and neurologic alterations that result from surgery with cardiopulmonary bypass. An approach for the management of the low output state is also provided. Little attempt has been made to focus on problems unique to a specific type of cardiac disease or certain operative approaches. Rather, it is the contention that an understanding of general principles and an appreciation of the common problems will provide adequate preparation for those responsible for the care of the child.
先天性心脏病患儿在心脏手术前后的药物治疗，对因手术进展而导致的发病率和死亡率的改善做出了重大贡献。本文提供了一个框架，用于理解围手术期出现的问题，并提供了一种按器官系统对这些问题进行监测和管理的系统方法。讨论旨在具有普遍适用性，重点关注术后的初始稳定以及体外循环手术后出现的心肺、肾脏、代谢、血液学和神经学改变。还提供了一种低心排血量状态的管理方法。本文几乎没有尝试关注特定类型心脏病或某些手术方法所特有的问题。相反，本文的观点是，理解一般原则并认识常见问题将为负责照顾患儿的人员提供充分的准备。
