70例右位心患儿临床病例分析

发布时间：2018-03-08 09:16

本文选题：右位心　切入点：内脏反位　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨右位心的病因、临床表现、合并症、检查手段、治疗及预后。旨在进一步探索右位心的早期干预措施，以提高患儿的成活率和生存质量。方法：回顾性分析重庆医科大学附属儿童医院自1993年2月至2013年1月收治的70例右位心患儿住院病例资料，，并通过门诊随访及电话随访了解预后情况。从一般情况、临床表现、诊断方法及治疗预后方面分别进行分析。结果： 1.70例右位心患儿中，初诊年龄为0天～16岁8月（中位年龄5月），68.6%于婴儿时期首次诊断。男40例，女30例，男女比例：1.33:1。其中居于城镇44例（62.9%），乡村26例（37.1%）。 2.本组资料中镜像右位心26例（37.1%）、右旋心29例（41.5%）、右移心15例（21.4%）。 3.临床表现主要为心尖搏动点、最大心界、最强心音均在右侧，发绀(27.1%)，气促(41.4%)，心脏杂音(40%)，生长发育迟缓(27.1%)。单纯心脏位置异常者4例（5.7%），心脏位置异常+心血管结构畸形18例（25.7%），心脏位置异常+心血管结构畸形+内脏反位15例（21.4%），心脏位置异常+心血管结构畸形+其他畸形10例（14.3%），心脏位置异常+心血管结构畸形+内脏反位+其他畸形3例（4.3%），心脏位置异常+内脏反位7例（10%），心脏位置异常+其他畸形10例（14.3%），心脏位置异常+内脏反位+其他畸形3例（4.3%）。 4.本组资料中右位心常见并发症：肺炎45例（64.3%），肺动脉高压9例（12.9%），心力衰竭5例（7.1%）。 5.本组资料右位心行胸片检查57例（81.4%）、超声心动图检查65例（92.9%）、胸部CT检查12例（17.1%）、心导管检查4例（5.7%）、心电图检查26例（37.1%）。 6.本组资料中，无心血管结构畸形者24例(34.3%)，其中3例为右移心合并心外畸形，行原发疾病手术治疗，除死亡1例外，预后较好。合并心血管结构畸形者46例（65.7%），其中外科手术治疗者13例，死亡2例，放弃治疗1例，余10例预后较好。心导管介入治疗1例，预后好。未手术治疗者32例，死亡5例，放弃治疗15例，目前一般情况尚可者12例。 7.母孕期主要异常情况：孕早期感染21例（30%）、母孕期药物使用7例（10%）、高龄产妇6例（8.6%）。父母重要疾病史：母亲自然流产或死胎史4例（5.7%）、父亲慢性疾病3例（4.3%）。结论： 1．右位心临床表现多种多样，主要表现为心尖搏动点、最大心界、最强心音均在右侧，心脏杂音，发绀，气促，生长生长发育迟缓。 2．右位心常合并心血管结构畸形，最常见的并发症为肺炎。 3．超声心动图是诊断、随访右位心及心内结构畸形的首选方法。 4.右位心合并心血管结构畸形、心外畸形者，需外科手术或心导管介入治疗。 5.孕早期的感染可能是导致右位心形成的重要危险因素。
[Abstract]:Objective: to explore the etiology, clinical manifestation, complications, examination, treatment and prognosis of right heart. Methods: the data of 70 patients with right heart disease admitted from February 1993 to January 2013 in Children's Hospital affiliated to Chongqing Medical University were analyzed retrospectively, and the prognosis was analyzed through outpatient follow-up and telephone follow-up. The clinical manifestations, diagnostic methods and treatment and prognosis were analyzed respectively. Results:. 1.The first diagnosis age was 0 days and 16 years old on August (median age May) was 68.6%. Male 40 cases, female 30 cases, the ratio of male to female was 1.33: 1.44 cases were living in town, 62.9% were in town, 26 cases were in rural area. 2. There were 26 cases of mirrored right heart, 29 cases of right circumflex heart, and 15 cases of right shift. 3. The clinical manifestations were mainly apical pulsation point, maximal cardiac boundary, and strongest heart sound on the right side. Cyanosis 27.1D, shortness of breath 41.4m, cardiac murmur 40m, growth retardation 27.1g. There are only 4 cases with abnormal cardiac position, 18 cases with abnormal cardiac position, 18 cases with cardiovascular structural malformation, 15 cases with abnormal cardiac position malformation, 15 cases with visceral counterposition, and 21.41C with abnormal cardiac position. Abnormal visceral position Cardiovascular malformation other malformation 10 cases Cardiovascular structural malformation 10 cases Cardiovascular malformation Cardiovascular malformation Cardiovascular malformation other malformation of visceral antiposition 3 cases other deformity of visceral inversion 7 cases of abnormal position of heart 7 cases of abnormal visceral inversion and abnormal position of heart. There were 10 cases of his malformation and 3 cases of other deformities with abnormal heart position and visceral inversion. 4. The common complications of right heart in this group were pneumonia in 45 cases (64.3%), pulmonary hypertension in 9 cases (P < 0.01), heart failure in 5 cases (P < 0.01). 5. Right chest radiography was performed in 57 cases, echocardiography in 65 cases (92.9%), chest CT in 12 cases (17. 1%), cardiac catheterization in 4 cases (5. 7%), electrocardiogram in 26 cases (37. 1%). 6. In this group, 24 patients without cardiovascular structural malformation were diagnosed as right heart shift combined with extracardiac malformation, 3 of them underwent surgical treatment of primary diseases, except for one death, 3 of them were diagnosed as right heart shift combined with extracardiac malformation. The prognosis was better in 46 patients with cardiovascular structural malformation, including 13 cases of surgical treatment, 2 cases of death, 1 case of abandonment of treatment, and 10 cases of better prognosis. Cardiac catheterization was performed in 1 case, prognosis was good in 32 cases, and no surgical treatment was performed in 32 cases. 5 cases died, 15 cases gave up treatment, 12 cases were normal at present. 7. The main abnormal conditions during pregnancy were as follows: 21 cases of early pregnancy infection, 7 cases of drug use during pregnancy, and 6 cases of elderly women, respectively. The history of important diseases of parents: 4 cases of spontaneous abortion or stillbirth history of mother, 3 cases of father's chronic disease, 3 cases of father's chronic disease. Conclusion:. 1. The clinical manifestations of right heart were varied, including apical pulsatile point, maximal cardiac boundary, strongest heart sound on the right side, cardiac murmur, cyanosis, shortness of breath and growth retardation. 2. Right heart is often associated with cardiovascular malformation. Pneumonia is the most common complication. 3. Echocardiography is the first choice in the diagnosis and follow-up of right ventricular and intracardiac malformations. 4. The right heart with cardiovascular malformation or extracardiac malformation should be treated by surgery or cardiac catheterization. 5. Infection in early pregnancy may be an important risk factor for right ventricular formation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4

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