Is it worth the risk?
Is it worth the risk?
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值得冒这个风险吗？
DOI：
10.1111/j.1460-9592.2007.02198.x
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发表时间：
2007
影响因子：
1.7
通讯作者：
Jesus S. Apuya
中科院分区：
文献类型：
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作者：
Jesus S. Apuya
先天畸形的两种模式;它们共存的引用发生率从低至1.3%到高达51%不等（3，4）。新生儿先天性心脏病的诊断是复杂的生理变化，发生在出生后的时期。即使进行了详细的产前心脏扫描和临床检查，仍有高达30%的病例可能被遗漏。这些漏诊病例中有多达一半可能是严重的，表现为心力衰竭或猝死（5，6）。围手术期患儿低血氧饱和度最常见的原因是呼吸功能不全。排除呼吸原因，在持续低饱和度的患者中，必须关注心内或心肺分流的存在（7）。我们的病人显示低饱和度，尽管插管和50%的氧气通气。这个病例确定了一些重要的要点：麻醉儿童在30%氧气下的正常饱和度应该> 96%。如果不能做到这一点，就必须寻求解释。对于先天性心脏病，术前评估者必须高度怀疑有先天性心脏病的可能性，即使是在扫描结果不明显的情况下。这使得测量和记录的术前饱和度的患者有必要提出手术的裂隙缺损。M. Taylor* C.佩尔萨 * S.英国伯明翰大学医院和伯明翰儿童医院（电子邮件：persadcindy@hotmail.com）
the two patterns of congenital deformity; quoted incidences for their coexistence vary from as low as 1.3% to as high as 51% (3,4). The diagnosis of congenital heart disease in the newborn is complicated by the physiologic changes that occur in the postnatal period. Even with a detailed cardiac antenatal scan and clinical examination up to 30% of cases can be missed. As many as half of these missed cases can be severe, presenting with heart failure or sudden death (5, 6). The most common cause of low saturations in the perioperatve child is respiratory insufficiency. Exclusion of respiratory causes, in a patient with persistently low saturations, must raise concerns about the presence of an intracardiac or cardiopulmonary shunt (7). Our patient displayed low saturations despite being intubated and ventilated with 50% oxygen. This case identifies some important points: The normal saturation of an anesthetized child on 30% oxygen should be >96%. If this cannot be achieved then an explanation must be sought. The preoperative assessor of a child with a cleft defect must maintain a high index of suspicion of associated congenital heart disease even in the face of unremarkable scans. This makes the measurement and documenting of preoperative saturations necessary in patients with cleft defects presenting for surgery. M. Taylor* C. Persad* S. Jones† *University Hospitals Birmingham and †Birmingham Children’s Hospital, Birmingham, UK (email: persadcindy@hotmail.com)