程玺 宋云林

[摘要] 先天性心脏病术后的液体管理极为重要，针对接受心脏外科手术的患儿，术后发生液体超负荷的风险极大，而术后早期液体超负荷与患儿较差的预后独立相关。先天性心脏病术后出现的液体过载有延长术后伤口愈合、增加伤口感染率、导致急性肺水肿、增加急性肾损伤及多脏器功能衰竭发生的风险。早期液体负平衡管理疗法应用在先天性心脏病患儿术后的治疗中取得令人满意的效果，可改善患儿心肺功能、缩短患儿术后恢复时间，减少住院时间，节约医疗资源，值得在临床推广使用。

[关键词] 液体超负荷;液体负平衡;婴幼儿;先心病

[中图分类号] R726.5          [文献标识码] A          [文章编号] 1673-9701（2021）32-0188-05

[Abstract] Fluid management after congenital heart surgery is extremely important. For children undergoing cardiac surgery， there is a great risk of fluid overload after surgery. Early postoperative fluid overload is independently associated with a poor prognosis in children. Fluid overload after congenital heart surgery may prolong postoperative wound healing， increase the risk of wound infection， cause acute pulmonary edema， and increase the risk of acute kidney injury and multiple organ failure. The application of early negative fluid balance management therapy in the postoperative treatment of children with congenital heart disease has achieved satisfactory results. It can improve the cardiopulmonary function of the children， shorten the postoperative recovery time of the children， reduce the length of hospitalization， and save medical resources. It is worthy of being widely popularized in clinical practice.

[Key words] Fluid overload; Negative fluid balance; Infants and young children; Congenital heart disease

先天性心脏病（Congenital heart disease，CHD），以下简称先心病，是指由于心脏和主要血管结构发育的非胚胎性畸形而导致的出生时的缺陷。先心病发生在大约1%的或早产儿中，大约有35种公认的心脏缺陷单独或合并发生，其严重程度从血流动力学上微不足道到及其复杂和危急生命等[1]。虽然可能有遗传或环境因素影响心脏缺陷的发生，但大多数情况下多为多因素的，无特定的诱发因素。有相关研究指出，母体怀孕期间過量饮酒和使用药物，怀孕前3个月病毒感染等都是先心病的相关诱因，占所有婴儿死亡的3%，占先天性畸形死亡的46%[2]。先心病的诊断、治疗和外科手术的显著进步使先心病的死亡率明显下降，手术死亡率目前在5%范围内[3]。先心病的患儿出生后如果得不到及时、正确的诊治将很快死亡。……