目的 探索降钙素原(procalcitonin,PCT)在小儿体外循环(cardiopulmonary bypass,CPB)心脏术后早期的自然变化规律及其影响因素.方法 采用观察性临床研究方法,对2018年6月-2019年12月阜外医院小儿心脏外科中心重症监护病房(pediatric intensive care unit,PICU)收治的年龄3岁以下、先天性心脏病(先心病)手术风险矫正评分(risk adjustment of congenital heart surgery,RACHS)2～5级、CPB下手术、无术前感染或炎性疾病的患儿,连续测定术前至术后第7d的PCT、C-反应蛋白(c-reactive protein,CRP)、白细胞(white blood cell,WBC)计数,同时行痰培养和胸部X线片检查,对体温＞38℃的患儿行血培养,对伤口化脓的患儿行伤口分泌物培养.统计术后7 d内感染及并发症情况,根据术后7 d内有无感染和并发症将入组患儿分为4组:感染+并发症组、单纯感染组、单纯并发症组以及正常组.结果 最终选择住PICU≥4 d的患儿为研究对象,共429例患者入选,其中男268例、女161例,年龄8.0(0.7,26.0)个月.包括单纯感染组145例、单纯并发症组38例、正常组230例以及感染+并发症组16例.小儿CPB心脏术后PCT、CRP、WBC均较术前明显升高,其中CRP、WBC在术后第2 d达到高峰,一直持续到术后第7 d仍高于正常.PCT在术后第1 d达到高峰,一般在术后第5 d降至正常.年龄、体重、RACHS评分、CPB及主动脉阻断时间均与术后早期PCT浓度有一定程度相关性.单纯感染组、单纯并发症组及正常组之间两两比较,年龄、体重、RACHS评分、CPB及主动脉阻断时间等基础资料差异无统计学意义.其中单纯感染组与正常组术后第3～7 d的PCT浓度差异具有统计学意义(P＜0.01),单纯并发症组与正常组术后第1～7 d的PCT浓度差异均有统计学意义(P＜0.01),单纯感染组与单纯并发症组术后第1～5 d的PCT浓度差异有统计学意义(P＜0.05).结论 小儿CPB心脏术后WBC、CRP、PCT均明显升高,从其动态变化趋势看,三者相比,PCT更能预警术后早期感染或并发症的存在.影响小儿CPB心脏术后早期PCT浓度的因素包括年龄、体重、RACHS评分、CPB和主动脉阻断时间、感染以及并发症.

目的 先天性心脏病患儿术后血淀粉酶升高在既往已有研究报道.对于血淀粉酶变化趋势的规律研究较少.本研究旨在探索先天性心脏病术后患儿血淀粉酶变化趋势及对于血淀粉酶升高峰值延迟原因的探索.方法 本研究为一项回顾性研究.连续入组阜外医院2019年1月1日至2019年12月31日先天性心脏病术后(1个月至6岁)血淀粉酶升高大于正常值3倍以上的180名患儿.按照血淀粉是否在48 h内达峰值,分为两组,正常达峰组和延迟达峰组,比较两组在人口学基本特征、体外循环时间、先天性心脏病种类、手术方式、重症监护时间及有创呼吸机时间等的差别.探索血淀粉酶高峰延迟的影响因素.对于血淀粉酶峰值延后的因素探索采用logistic回归.结果 血淀粉酶在两组患儿性别、年龄、体质量指数等人口基本学特征、阻断时间、谷丙转氨酶、甘油三酯、肌酸激酶、乳酸最高值水平、淀粉酶最高值水平、呼吸机时间上无统计学差异.淀粉酶峰值在术后48 h后出现组右心病变的比例较高(P＜0.01),有更长的转机时间(P＜ 0.01),相对更长的ICU时间(P＜0.01).右心病变为术后淀粉酶峰值延迟的独立危险因素.结论 右心病变是血淀粉酶术后48 h仍处于上升趋势的独立危险因素.

目的 评估小剂量右美托咪定在紫绀型先天性心脏病术后镇痛镇静的疗效和安全性.方法 选取2019年(7～12)月紫绀型先天性心脏病患儿(n=151)接受镇痛镇静治疗,分为常规组(瑞芬太尼+咪达唑仑治疗,n=81)和联合组(再加用右美托咪定治疗,n=70).观察两组镇痛满意程度、儿科重症监护室(pediatric intensive care unit,PICU)停留时间等指标.结果 与常规组相比,联合组镇痛效果更好(P＜ 0.05);联合组使用的瑞芬太尼[(46±7) μg/(kg.h)vs.(28±4) μg/(kg·h)]和苯二氮卓类中咪达唑仑[(206±54)μg/(kg·h) vs.(139±21)μg/(kg·h)]用量更低(P＜0.05);疼痛临时干预比例更低(P＜0.05).机械通气时间和PICU停留时间两组无明显差异.结论 小剂量右美托咪定在紫绀型先天性心脏病术后镇痛镇静中具有良好效果,还可降低阿片类和苯二氮卓类药物的用量,安全可靠.

目的:探讨心肺联合超声(CPUS)在先天性心脏病(先心病)婴儿术后机械通气脱机评估中的临床应用价值.方法:选取2020年2～6月在中国医学科学院阜外医院经外科手术治疗先心病婴儿109例,平均年龄(0.70±0.25)岁,平均体重(7.48±1.49)kg.达到临床脱机标准后进行心肺联合超声检查,记录肺超声评分、左心室射血分数(LVEF)、肺动脉收缩压、畸形矫治情况与膈肌运动情况.同时记录临床监测以及血气分析指标,N末端B型利尿肽原(NT-proBNP).根据是否成功脱机分为脱机成功组(n=84)及脱机失败组(n=25),比较两组间参数,评价心肺联合超声参数对脱机失败的预测效能.结果:脱机成功组和脱机失败组性别、术前LVEF、心率、平均动脉压、中心静脉压、动脉血二氧化碳分压、合并肺动脉高压者差异无统计学意义(P均>0.05).脱机失败组术后LVEF、动脉血氧分压低于脱机成功组,肺超声评分、NT-proBNP以及合并膈肌功能障碍者高于脱机成功组(P均<0.05).以肺超声评分为标准预测脱机失败的ROC曲线下面积为0.84,最佳截断值为13分,敏感度为60％,特异度91％.Logistic回归分析示肺超声评分≥13分,LVEF<40％及膈肌功能障碍均与脱机失败显著相关(P均<0.05),联合预测脱机失败的ROC曲线下面积为0.88.结论:床旁心肺联合超声对先心病术后婴儿预测呼吸机撤离具有较高的可操作性及诊断价值.

目的 总结完全性大动脉转位(TGA)一期大动脉调转(ASO)术后早期临床特点及围术期处理策略,评价年龄结构及畸形复杂程度对术后恢复进程的影响,并分析导致术后ICU延迟恢复的相关风险因素.方法 回顾性分析2015-2017年我院连续231例行一期ASO手术的TGA患儿临床资料,其中男165例、女66例,年龄3d至10岁.按照术后ICU滞留时间从短到长排序,将排在第75％位点的ICU滞留时间定义为分组的界值.将患儿分为正常恢复组(177例)与延迟恢复组(54例),比较两组患儿的围术期临床资料,分析延迟恢复的危险因素.结果 231例患儿中,超龄患儿占比约一半(49.6％).延迟恢复组平均ICU滞留时间(23.9±15.6)d,而正常恢复组平均ICU滞留时间仅为(4.9±2.3)d.合并弓部病变、延迟关胸、术后肺部感染是ASO术后延迟恢复的独立影响因素,超龄对总体恢复并未产生显著影响.结论 严格把握手术适应证及良好的术后管理,绝大多数TGA患儿ASO术后仍可获得满意的早期效果,但面临并发症增加的问题,导致延迟恢复.合并弓部病变、延迟关胸、术后肺部感染是导致ASO术后延迟恢复的独立影响因素.

目的 评估先天性心脏病(先心病)术后阿司匹林抵抗现象及其与血栓发生的相关性.方法 纳入我院2016年8月至2017年12月52例术后口服阿司匹林抗血栓先心病患儿的临床资料,其中男29例、女23例,中位年龄8个月(6 d～13岁).服药后第3～5d行血栓弹力图血小板图检测.根据花生四烯酸(AA)抑制率＜50％和≥50％,将患儿分为阿司匹林抵抗组(14例)和阿司匹林敏感组(38例).随访出院3个月内血栓发生情况.结果 阿司匹林抵抗发生率26.9％,血栓事件3例(5.9％).14例阿司匹林抵抗的患者中,3例住院期间增加剂量后复测,结果显示1例转为阿司匹林敏感.单因素分析未发现阿司匹林抵抗的危险因素,且阿司匹林抵抗和血栓事件的相关性差(r=0.04,P=0.80).结论 先心病患儿术后阿司匹林抵抗发生率较高,但未发现其与血栓形成有相关性.部分患者增加剂量后抵抗消失,提示可能剂量不足.

目的 探讨婴儿期法洛四联症(tetralogy of Fallot,TOF)根治术后患儿快速康复(fast track,FT)的可行性及相关风险因素.方法 回顾性分析2017年1月至2017年12月我院年龄小于1岁TOF根治术病例156例.FT的定义为患者从手术室回PICU后24小时内撤离呼吸机.按照此定义,将患者分成FT组与非FT组.结果 总体达到FT治疗比例为71.8％.FT组机械通气时间、ICU住院时间比非FT组明显降低(P＜0.05).二元logestic回归分析发现右室压/左室压(RVP/LVP)大于60％、高LAP是FT治疗的独立危险因素.结论 FT对于大多数婴儿期TOF根治术后的患儿是可行的.RVP/LVP比值、LAP是影响FT治疗的风险因素.

Objective: To explore the clinical value of extravascular lung water monitoring for rapid recovery in pediatric patients after complete repair of tetralogy of Fallot (TOF). Methods: A total of 43 pediatric patients received complete repair of TOF were studied. The pulse contour cardiac index (PCCI), global end diastolic volume index (GEDI), stroke volume variation (SVV), systemic vascular resistance index (SVRI), global ejection fraction (GEF), maximum of pressure increase in aorta (dPmax), extravascular lung water index (EVWI) and pulmonary vascular permeability index (PVPI) were recorded by pulse-indicated continuous cardiac output (PICCO) monitoring at immediately enter pediatric ICU (PICU) and 6h, 12h, 18h, 24h post-operation. Meanwhile, the heart rate, blood pressure, central venous pressure (CVP), left atrium pressure (LAP) and balance of liquid were monitored; mechanical ventilation time, PICU stay time, re-intubation,re-occlusion of major aortopulmonary collateral arteries (MAPCAs) and other complications were recorded. Based on post-operative mechanical ventilation time, the patients were divided into 2 groups: Rapid recovery (R) group, patients with mechanical ventilation≤24h, n=29 and Delayed recovery (D) group, patients with mechanical ventilation>24h, n=14. Results: Compared with group D, group R had the shorter mechanical ventilation time (14.2±8.0) h vs (86.3±44.5) h and PICU stay time (2.5±1.7) days vs (5.3±3.6) days, both P<0.05; decreased PVPI at immediately enter PICU and 6h, 12h, 18h, 24h post-operation as (4.9±1.3 vs 6.4±1.5),(5.1±1.8 vs 6.5±1.3),(4.8±2.0 vs 6.5±1.6),(4.4±1.1vs 6.9±1.8), (4.4±2.5 vs 6.5±2.2) respectively, all P<0.05; Lower ELWI at 12h and 18h post-operation as(20.9±6.1) ml/kg vs (26.8±5.7) ml/kg and(19.1±5.5) ml/kg vs (26.7±5.5)ml/kg, both P<0.05. Group R had no patient received re-occlusion of MAPCAs after operation, while Group D had 3. No death, no catheter-related complication occurred in either group. Conclusion: MAPCAs may increase extravascular lung water, pulmonary vascular permeability and cause lung perfusion, therefore affect the early recovery of complete repair of pediatric TOF. PICCO monitoring may conduct bedside quantitative observation of lung perfusion, combining with ELWI and PVPI, clinicians may identify and manage MAPCAs as necessity for rapid recovery in relevant patients.

Objective To analyze the clinical characteristics of primary Sj?gren's syndrome ( pSS) complicated with pancreatic damage. Methods The clinical features, laboratory examinations, radiological findings, treatments, and outcome of 14 patients with pSS complicated with pancreatic damage admitted to Peking Union Medical College Hospital from January 2012 to April 2017 were summarized and retrospectively analyzed. Results Nine hundred and thirty pSS patients were admitted to Peking Union Medical College Hospital from January 2012 to April 2017, 14 of whom were complicated with pancreatic damage. Fourteen patients were all females with a median age of 54. 5 years. They presented asincluded abdominal pain ( 5/14 ) , nausea ( 5/14 ) , vomiting (3/14), diarrhea (2/14), abdominal distension (3/14), and fever (2/14). IgG was increased in seven patients (7/12), compliment was decresed in three (3/10) patients, ESR was elevated in eight (8/13) patients, and hsCRP was elevated in six (6/14) patients. There were six patients (6/9) with elevated serum amylase and five patients ( 5/9 ) with elevated blood lipase. Abnormal abdominal ultrasound results were found in three patients (3/8) and abnormal computerized tomography were found in ten patients ( 10/13). 60% ( 6/10) patients achieved clinical improvements, who were mainly treated with steroids and immunosuppressive agents combined with treatments of pancreatitis. Conclusions Pancreatic damage is rare in patients with pSS. Most of the patients suffered from pancreatic dysfunction and were abnormal in abdominal computerized tomography. Some of the patients did not present with gastrointestinal symptoms, which may cause missed diagnosis.

Objective To recognize the risk factors of unplanned re-interventions within 30 days after pediatric cardiac surgery and evaluate the outcome of re-interventions. Methods We retrospectively analyzed the clinical data of 202 children in Fuwai Hospital between January 1, 2015 and August 31, 2017. There were 115 males and 87 females at average age of 32.4 months with range of 3 days to 14 years. Results There were 202 children who underwent unplanned re-intervention during 30 days post-operation, including 54 re-adjustments of pulmonary blood flow, 34 re-corrections for residual cardiac abnormalities, 28 cardiopulmonary resuscitations, 38 for coagulation problems, 19 pericardial drainages, 11 palliative re-operations to deliver heart load and 6 diaphragmatic folds and 12 others. The mortality rate among children who underwent unplanned re-inventions after cardiac surgery was 10.9％ (22/202). It was much higher than those free from re-interventions (0.7％). Time of mechanical ventilation was 284.3 (11-2 339) h, and mean ICU stay was 17.7 (1-154) d, significantly longer than those free from re-interventions at the same period. Conclusion Unplanned reinterventions after pediatric cardiac surgery is associated with higher mortality rate and longer recovery time. Early identifying risk factors and re-intervention can reduce the complications and improve the prognosis.

Objective To analyze the incidence rate of postoperative coagulopathy for pediatric patients with congenital heart disease (CHD) by thromboelastograph(TEG).Methods 661 pediatric patients after cardiac surgery with CPB were divided into two groups by the type of CHD and oxygen saturation,cyanotic group(n=198)and acyanotic group(n=463) and put in subgroups based on age.All of them received TEG measurement postoperatively.TEG results were then recorded and compared between two groups.Results There were 306 patients(46.3％)postoperatively with the abnormal TEG results mainly because of platelet dysfunction (43.7％),other including low fibrinogen(13％) and low clotting factors(4.2％).For cyanotic group,it's significant higher compared to acyanotic group,63.4％ and 39.7％,respectively.The rate of low clotting factors and fibrinogen were both high in cyanotic group than those acynotic group,P＜0.01,while the platelet dysfunction rate was similar between two groups,P＞0.05.The subgroup analyses found that patients younger than 1 year old,the incidence of postoperative coagulopathy with abnormal TEG results was higher than other patients.However,low fibrinogen and platelet dysfunction are more often in cyanotic patients under 1 to 3 years old.Conclusion According to TEG monitoring,pediatric patients after cardiac surgery are more likely to suffer from coagulopathy,mainly because of platelet dysfunction.Younger children and cyanosis may also be some of the high risk factors contributing to postoperative coagulopathy.Older cyanotic chlidren is also the high risk population.

Objective To investigate the methods of early identification and early intervention for newborn with life-threatening congenital heart disease.Methods Between January 2010 and December 2010,223 neonates with serious congenital cardiac malformations were hospitalized in PICU of Fuwai Hospi-tal.Results The most type of cardiac lesions was complete transposition of the great arteries,accounting for 59%(131 cases),and the second was total anomalous pulmonary venous connection,17%(39 cases).For the primary clinical symptoms,the most common were any cyanosis,dyspnea and cardiac murmur,accounting for 91 %(204 cases),56%(125 cases)and 53%(1 18 cases),respectively.Fifty-nine cases developed into critical conditions such as severe hypoxia,metabolic acidosis and heart failure and were sent to PICU for emergency rescue.Early intervention included maintaining ductus arteriosus open,correcting internal environ-ment disturbances,treatment of heart failure,and surgical treatment as soon as possible.Four cases died before operation and 10 cases were abandoned to continue care,which all died within 12 days after discharge.In 209 cases who received operation,9 cases died.The total operation mortality was 4.3%.Within 3 to 63 month following-up,the late death was in 2 cases,2 cases received two-stage corrective operation,and three for reop-eration.The others all were in normal cardiac function and growth.Conclusion Most of neonatal life-threat-ening congenital cardiac malformations were ductus dependent such as transposition of the great arteries and total anomalous pulmonary venous connection,which the baby needs immediate diagnosis and management for survival.Early recognition,appropriate preoperative management and operation as soon as possible are the key to rescue.

目的：随着小儿心脏外科整体治疗水平的提高，与先心病外科治疗相关的死亡率和并发症都获得了极大的改善。在这种低死亡率的背景下，如何进一步促进低龄复杂先心病的快速康复，降低ICU滞留时间和总住院时间，成为小儿外科中心新的工作目标。本文探讨低龄复杂先心病外科术后早期拔管的可行性及相关风险因素。

目的：小儿心脏术后早期并发肺部感染是导致重症患儿延迟恢复的主要因素。既往临床上对肺部感染的诊断指标主要是结合临床、微生物学证据以及一些非特异性生物标志物如C反应蛋白（CRP）、白细胞（WBC）计数等综合考虑。在一定程度上存在有诊断延迟或特异性低的问题，从而可能延迟最佳的治疗时机。降钙素原（PCT）作为一种新型的生物标志物，有可能对心脏术后早期感染的诊断发挥更为重要的作用。

Neonatal lupus erythematosus (NLE)is a passively acquired autoimmune disease associated with maternal anti-Ro/SSA,anti-SSB/La and anti U1RNP antibodies,of which fetal heart involvement is the most serious clinical manifestations.The molecular mechanisms are not fully understood, but several targets for the maternal autoantibodies in the fetal heart have been suggested.Recent studies also indicate that environmental factors and fetal susceptibility genes determine whether an autoantibody-exposed fetus will develop congenital heart block (CHB)or not.Prenatal application of fluorinatedcorticosteroids,hydroxychloroquine,intravenous immunoglobulin (IVIG),and plasmapheresis have been under investigation,but the results are controversial.In this article,we reviewed the advances in the pathogenesis and treatment of NLE with cardiac involvement in order to pursue early interventions.

Objective To investigate the risk factors of early extubation ( EE ) in pediatric patients after total endocardial cushion defect ( TECD ) surgery , EE is defined as extubation in the operation room or after the return of intensive care unit ( ICU ) within 24 h.Methods A total of 59 patients underwent TECD repair in the Pediatric Surgery Department of Fuwai Hospital from January 2013 to December 2014, excluding 3 cases, the remaining 56 cases according to EE were divided into EE group and non EE group ,EE group included 34 patients, 15 male and 19 female with their age of (30.15 ±29.15 ) months,weight of (13.73 ±16.02 ) kg;non EE group included 22 patients,9 male and 13 female with their age of(11.49 ±5.59)months,weight of(7.94 ±5.66)kg. Results One patient died postoperatively because of severe atrioventricular valve regurgitation and finally caused heart failure and ARDS .The mechanical ventilation and ICU stay were 12.1 hours and 2.6 days respectively in EE group,which were significantly prolonged in non EE group ( 58.3 h and 7.1 d respectively ) .Small age ( P =0.010),low weight(P=0.025)and postoperative mitral regurgitation (P<0.001)were the main influence factors of early extubation in children after TECD .Conclusions Most patients after TECD repair can achieve early&nbsp;extubation .Small age ,low weight and postoperative mitral regurgitation are the risk factors of EE .

目的:观察并评价吸入一氧化氮联合西地那非治疗全腔静脉-肺动脉连接术(TCPC)后早期肺动脉高压(PAH)的安全性.方法:分析2010年1月至2014年12月,阜外心血管病医院采取吸入一氧化氮(iNO)联合西地那非治疗的56例TCPC术后,早期合并PAH患儿的临床资料,PAH的诊断标准为:①术前平均肺动脉压力(mPAP)≥13mmHg(1mmHg=0.133kPa);②术后早期循环不稳、中心静脉压(CVP)≥15mmHg或跨肺压差(TPG,即中心静脉压与左心房压的压力差值)≥10mmHg.男性37例,女性19例,平均年龄(63.3±23.9)rn,平均体质量(17.5±4.1)kg,术前平均肺动脉压力(mPAP)(14.7±1.5) mmHg,平均左心室射血分数(63.1±6.3)％,术前经皮氧饱和度(79.2±7.3)％,术前血红蛋白含量(180.1±24.6)g/L.分别记录治疗开始前、治疗开始后24小时的各项血流动力学和呼吸功能指标,定期监测二氧化氮(NO2)、高铁血红蛋白(MetHb)含量、血小板及肝肾功能.结果:56例TCPC术后早期合并PAH患儿经iNO联合西地那非治疗后,循环逐步稳定,容量需求、胶体入量及血管活性药评分减少,CVP从(15.2±3.2)mmHg降至(11.2±2.2)mmHg,TPG从(10.8±2.5) mmHg降至(5.8±1.8)mmHg,氧合指数从(203±77) mmHg升至(278±90) mmHg.iNO联合西地那非治疗期间,NO2浓度均＜1 ppm,平均0.3(0.1,0.5)ppm;MetHb均在3％以下,平均(1.5±0.5)％,均属于安全范围;无患儿出现血小板减少、肝肾功能异常及明显不良反应的表现.结论:吸入一氧化氮联合西地那非在TCPC术后早期PAH患儿中应用是安全可行的.

目的 总结全腔静脉肺动脉连接术(total cavopulmonary connection,TCPC)经房间隔开窗治疗复杂先天性心脏病的早期疗效.方法 回顾性分析2010年1月至2013年12月阜外心血管病医院142例行TCPC患儿的临床资料.根据其是否行房间隔开窗分为2组:开窗组,71例,男44例、女27例,年龄(65.7±24.5)个月;未开窗组,71例,男42例、女29例,年龄(60.7±20.8)个月.比较两组患儿围术期资料.结果 142例患儿术后早期死亡4例(2.82％).术前合并有中大量房室瓣反流(AVVI)并同期矫治的患儿行房间隔开窗的比例大大增加.两组患儿的机械通气时间、住ICU时间、早期死亡率及并发症发生率差异均无统计学意义(P＞0.05),但开窗组较未开窗组患儿术后胸腔积液持续时间更短(9.1 dvs.13.1 d)、24h容量需求亦更低[4.19 ml/(kg·h)vs.5.48 ml/(kg·h)].对于术前平均肺动脉压(mPAP)≥12 mm Hg者,开窗组患儿术后早期中心静脉压(CvP)较未开窗组更低(P=0.046),维持相同的血压(收缩压80～90 mm Hg)开窗组所需的血管活性药评分(P=0.019)、24 h容量需求(P=0.041)均更低,胸腔积液持续时间更短(9.8 d vs.17.8 d,P=0.000).对113例复诊患儿进行随访,平均随访时间(1.1±1.2)年,发现开窗患儿动脉血氧饱和度(SpO2)为92.1％±3.5％,开窗患儿窗口自然闭合率为8.5％,无患儿发生严重紫绀(SPO2＜85％)、肢体栓塞及脑卒中.结论 对TCPC患儿无需常规开窗,开窗与未开窗患儿均可获得满意的早期临床疗效,但对于合并有中大量AVVI并同期矫治、尤其是mPAP≥12 mm Hg的高危患儿应考虑行房间隔开窗,开窗有助于术后早期循环的稳定,缩短胸腔积液持续时间.

目的：总结左冠状动脉起源异常患儿根治术后早期处理的经验，提高治疗效果。<br>　　方法：2010-01至2015-01，阜外医院小儿外科中心共手术根治左冠状动脉起源异常46例，病人的一般资料，男性28例，女性18例；年龄：中位数17 m，四分位间距（7 m，55.8 m）；体重（13.6±10.8）kg。术前例经超声和增强CT检查确诊，异常起源的左冠状动脉均发自肺动脉。以左射血分数50%为标准，术前心功能正常28例，超声、CT均提示冠脉之间有侧支形成；心衰18例，超声及CT未发现明显侧支形成，或侧支形成不充分。8例存在二尖瓣中大量以上反流，以前瓣脱垂为主。

目的：探索TOF根治术后早期心功能指标、压力指标、容量指标以及肺水指标的变化，评估PICCO技术在指导TOF根治术后早期治疗中的临床价值。<br>　　方法：小儿TOF根治术后病例38例，于返回PICU后置入PICCO监测导管，经中心静脉导管注射冰盐水，机器自动测量并计算心指数（CI）、全心舒张末期容量指数（GEDI）、全心射血分数（GEF）、血管外肺水指数（EVWI）及肺血管通透性指数（PVPI），并连续监测心输出量指数（PCCI）、左心室收缩力指数（dPmx）、每搏量变化率（SVV）及外周血管阻力指数（SVRI）等参数。此后，每6小时注射冰盐水一次，记录上述各参数。根据临床恢复结果将病例分为快速康复组和延迟恢复组，应用SPSS19统计软件对两组资料进行统计学分析。