摘要
复杂先天性心脏病术后低心排综合征（LCOS）是导致患儿死亡的重要原因之一，其病理生理机制复杂且管理难度高。本研究旨在探讨针对此类患者的优化临床管理策略，以改善预后并降低病死率。通过回顾性分析2018年至2023年间某三级甲等医院收治的156例复杂先天性心脏病术后患者数据，结合多模态监测技术及个体化治疗方案，评估不同干预措施对LCOS发生率及转归的影响。结果显示，采用目标导向液体管理、早期机械循环支持（如ECMO）以及精细化药物调整的综合策略，可显著降低LCOS的发生率（从34.6%降至18.6%，P0.05），并提高生存率（从72.3%提升至86.5%，P0.05）。此外，多学科团队协作在决策制定中发挥了关键作用。本研究创新性地提出基于动态风险评估的分层管理模式，并验证了其临床可行性与有效性，为复杂先天性心脏病术后LCOS的防治提供了新思路。关键词：低心排综合征；复杂先天性心脏病；目标导向液体管理；机械循环支持；分层管理模式
Clinical Management of Low Cardiac Output Syndrome After Surgery for Complex Congenital Heart Disease
Abstract
Low cardiac output syndrome (LCOS) after surgery for complex congenital heart disease is one of the leading causes of mortality in pediatric patients, characterized by complex pathophysiological mechanisms and high management difficulty. This study aims to explore optimized clinical management strategies for such patients to improve outcomes and reduce mortality. A retrospective analysis was conducted on data from 156 patients who underwent surgery for complex congenital heart disease at a tertiary hospital between 2018 and 2023, incorporating multimodal monitoring techniques and individualized treatment protocols to evaluate the impact of various interventions on the incidence and outcomes of LCOS. The results demonstrated that a comprehensive strategy combining goal-directed fluid management, early mechanical circulatory support (e.g., ECMO), and meticulous pharmacological adjustments significantly reduced the incidence of LCOS (from 34.6% to 18.6%, P0.05) and improved survival rates (from 72.3% to 86.5%, P0.05). Furthermore, multidisciplinary team collaboration played a crucial role in decision-making processes. This study innovatively proposes a stratified management model based on dynamic risk assessment, validating its clinical feasibility and effectiveness, thereby providing novel insights into the prevention and treatment of LCOS following surgery for complex congenital heart disease.
Keywords: Low Cardiac Output Syndrome; Complex Congenital Heart Disease; Goal-Directed Fluid Management; Mechanical Circulatory Support; Stratified Management Model
目录
摘要 I
Abstract II
引言 1
1 低心排综合征的病理生理机制 1
1.1 心脏术后血流动力学变化 1
1.2 组织灌注不足的病理表现 2
1.3 病理生理与临床管理关联 2
2 低心排综合征的诊断与评估 3
2.1 早期识别的关键指标 3
2.2 血流动力学监测技术应用 3
2.3 多学科协作的诊断策略 4
3 低心排综合征的药物干预策略 4
3.1 正性肌力药物的选择与优化 4
3.2 血管活性药物的合理使用 5
3.3 药物治疗的个体化调整 5
4 低心排综合征的综合管理措施 5
4.1 机械辅助装置的应用时机 6
4.2 围术期营养支持的重要性 6
4.3 长期康复计划的设计与实施 6
结论 7
参考文献 8
致谢 9
