发绀型先天性心脏病

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1、CyanoticHeartLesionsNeonatalIntensiveCareNurseryNightCurriculumSeriesCyanosisArterialsaturationlessthan90%andaPO2lessthan60torrInallcyanoticheartlesionstheamountofcyanosisseenisdependentontheamountofpulmbloodflowDecreasedPBF-increasedcyanosisIncreasedPBF-minimal

2、cyanosisbutCHFmaydevelopWith100%oxygenPO2>250isnotcongenitalheartdiseasePO2<100iscardiacdisease5“T’s”MostcommoncyanoticlesionsofthenewbornTetralogyofFallotTranspositionoftheGreatArteriesTruncusArteriosusTotalAnomalousVenousReturnTricuspidAtresiaGeneralSourcesofA

3、rterialSaturationDecreasedPulmonaryBloodFlowAdmixtureLesionsIncreasedPulmonaryBloodFlowTetralogyofFallotTranspositionofGreatVesselsTrunciousArteriosusTricuspidAtresiaAnomalouspulmonaryvenousreturnPulmonaryAtresiaPGEForcyanoticheartlesionswithreducedbloodflowRE-o

4、pensPDAandpreventsitfromclosingAllowspartiallydesaturatedsystemicarterialbloodtoenterthepulmonaryarteryandbeoxygenatedInitialdose0.1mg/kg/minSideeffects-apnea,fever,hypotensionCompleteTranspositionoftheGreatArteries5%ofallCHDBoys3:1Mostcommoncyanoticconditiontha

5、trequireshospitalizationinthefirsttwoweeksoflifeCompleteTranspositionoftheGreatArteriesAortaarisesfromtherightventriclePulmonaryarteryarisesfromtheleftventricleCompleteTranspositionoftheGreatArteriesCompleteseparationofthe2circuitsHypoxemicbloodcirculatingintheb

6、odyHyperoxemicbloodcirculatinginthepulmonarycircuitCompleteTranspositionoftheGreatArteriesDefecttopermitmixingof2circulations-ASD,VSD,PDA.VSDispresentin40%ofcasesNecessaryforsurvivalClinicalSymptomsDependonanatomypresentNomixinglesionandrestrictivePFOProfoundhyp

7、oxiaRapiddeteriorationDeathinfirsthoursoflifeAbsentrespiratorysymptomsorlimitedtotachypneaSinglesecondheartsound,nomurmursClinicalSymptomsMixinglesionpresent(VSDorlargePDA)LargevigorousinfantCyanoticLittletonorespdistressMostlikelytodevelopCHFinfirst3-4monthsofl

8、ifeexcessivesweating(acold,clammysweatoftennotedduringfeeding);poorfeeding,slowweightgain,irritabilityorlethargy,and/orrapidbreathingCXREggshapedcardiacsilhouetteNarr