TruncusArteriosus共同動脈干電子教案

1、Good is good, but better carries it.精益求精，善益求善。TruncusArteriosus共同動脈干-TruncusArteriosus共同動脈干HYPERLINK/heart/greystone/children/truncus.htmHYPERLINK/heart/greystone/children/truncus.htmclickimagetoenlargeWhatistruncusarteriosus?什么是共同動脈干？Truncusarteriosusisacongenital(presentatbirth)defectthatoccursdue

2、toabnormaldevelopmentofthefetalheartduringthefirst8weeksofpregnancy.Theheartbeginsasahollowtube,andthechambers,valves,andgreatarteriesdevelopthroughoutthefirst8weeksofpregnancy.Theaortaandpulmonaryarterystartasasinglebloodvessel,whicheventuallydividesandbecomestwoseparatearteries.Truncusarteriosusoc

3、curswhenthesinglegreatvesselfailstoseparatecompletely,leavingaconnectionbetweentheaortaandpulmonaryartery.共同動脈干是一種先天性心臟病(出生時即有的)是由于在妊娠的頭8周里胎兒心臟發(fā)育異常造成的。心臟開始是一個中空管，并且心腔、瓣膜、和大血管的發(fā)育貫穿這妊娠的頭8周。主動脈和肺動脈在開始時是一個血管，以后分隔成兩個動脈。當(dāng)這個大血管沒有完全分開時，在主動脈和肺動脈之間留下連接處。Truncusarteriosisisacomplexdefectwherethereisasingle(nor

4、mallytherearetwoseparatearteries)vesselarisingfromtheheartthatformstheaortaandpulmonaryartery.Anothercongenitalheartdefectthatoccurswithtruncusarteriosusisaventricularseptaldefect(ventricularseptum,ordividingwallbetweenthetwolowerchambersoftheheartknownastherightandleftventricles).共同動脈干是一種復(fù)雜的缺陷，一個單一

5、的血管從心臟發(fā)出，（正常時是兩個互相分開的動脈）。與共同動脈干相伴的另外的心臟缺損是心室間隔缺損。HYPERLINK/heart/greystone/children/truncus.htmHYPERLINK/heart/greystone/children/truncus.htmclickimagetoenlargeNormally,therearetwoseparatearteries(theaortaandthepulmonaryartery.Oxygen-poor(blue)bloodreturnstotherightatriumfromthebody,travelstotherigh

6、tventricle,thenispumpedthroughthepulmonaryarteryintothelungswhereitreceivesoxygen.Oxygen-rich(red)bloodreturnstotheleftatriumfromthelungs,passesintotheleftventricle,andthenispumpedthroughtheaortaouttothebody.正常時，這兒是兩個互相分開的動脈（主動脈和肺動脈。靜脈血（蘭）從全身回到右心房，進(jìn)入右心室，然后泵出經(jīng)肺動脈進(jìn)入肺，在這里吸收氧。動脈血（紅）從肺里回到左心房，進(jìn)入左心室，然后泵出經(jīng)主

7、動脈到達(dá)全身）。Intruncusarteriosus,oxygen-poor(blue)andoxygen-rich(red)bloodmixbackandforththroughtheventricularseptaldefect.Thismixedbloodthenflowsthroughthecommontruncalvessel.Someofitwillflowthroughthebranchthatbecomesthepulmonaryarteryandontothelungs,andsomeofthemixedbloodwillgointotheaorticbranchandco

8、ntinuetothebody.Themixedbloodthatgoestothebodydoesnothaveasmuchoxygenasnormal,andwillcausevaryingdegreesofcyanosis(bluecoloroftheskin,lips,andnailbeds).在共同動脈干的病例，貧氧血（蘭）和富氧血（紅）經(jīng)過室間隔缺損來回的混合，然后這混合的血液經(jīng)過這共同的血管，一部分進(jìn)入成為肺動脈的分支到達(dá)肺里，而另一部分則進(jìn)入主動脈的分支繼續(xù)流到全身?；旌系难獩]有帶上正常的那么多的氧到達(dá)全身，就會引起不同程度的紫紺。（皮膚、口唇、和甲床呈藍(lán)色）Truncusar

9、teriosusoccursinlessthanoneoutofevery10,000livebirths.Itmakesup1percentofallcasesofcongenitalheartdisease.共同動脈干的發(fā)生在每一萬新生兒中少于一個。在所有的先天性心臟病中達(dá)1。Whatcausestruncusarteriosus?什么引起共同動脈干？Somecongenitalheartdefectsmayhaveageneticlink,eitheroccurringduetoadefectinagene,achromosomeabnormality,orenvironmentalex

10、posure,causingheartproblemstooccurmoreoftenincertainfamilies.Othertimesthisheartdefectoccurssporadically(bychance),withnoclearreasonforitsdevelopment.某些先天性心臟病可能帶有遺傳鏈接，由于基因缺陷，染色體異常，或環(huán)境暴露，任何一項引起心臟問題較常發(fā)生在某些家庭。其他情況下，心臟病的發(fā)生是偶然的，對于它的發(fā)展沒有明確的原因。Whyistruncusarteriosusaconcern?為什么關(guān)注共同動脈干？Thebloodthatpassesthr

11、oughthecommontruncalvesselhasaloweroxygencontentthannormal.Oxygen-poor(blue)bloodfromtherightventricleandoxygen-rich(red)bloodfromtheleftventriclemixtogetherbeforeenteringthecommonvessel.Someofthismixedbloodwillgointotheaortaandontothebody,producingcyanosis(bluecoloroftheskin,lips,andnailbeds).通過共同動

12、脈的血流的含氧量較正常的低。在進(jìn)入共同血管之前，來自右心室的貧氧血（蘭）和來自左心室的富氧血（紅）混合在一起。這混合血的一部分進(jìn)入主動脈供應(yīng)全身，產(chǎn)生紫紺（皮膚、口唇、和甲床呈藍(lán)色）。Thepulmonaryarterysectionofthecommonvesselgetsmorebloodflowthantheaortadoes,becausethepressureislowerinthelungsthanthebodyanditiseasierforbloodtotravelinthatdirection.Ifnotrepaired,thebloodvesselsinthelungsbe

13、comedamagedbytheextrabloodflow.Asthepressureinthebloodvesselsinthelungsbecomeshigher,lessbloodgoestothelungsandmoregoestothebody.Cyanosisbecomesworseasbloodwithloweramountsofoxygentravelstothebody.這共同血管的肺動脈部分得到比主動脈多的血液，因為肺的壓力比全身的壓力低，所以血液容易流入。如果不矯治，肺內(nèi)的血管就會被過多的血流損傷。隨著肺內(nèi)血管的壓力增高，到肺的血減少而到全身的血增加。隨著到全身的血液攜

14、帶的氧量的減少，紫紺變得更嚴(yán)重。Whatarethesymptomsoftruncusarteriosus?TA有什么癥侯群？Thefollowingarethemostcommonsymptomsoftruncusarteriosus.However,eachchildmayexperiencesymptomsdifferently.Symptomsmayinclude:以下是TA最常見的癥侯群。然而，每一個患兒可能經(jīng)歷的癥侯群有所不同。癥候群可能包括：cyanosis紫紺fatigue疲勞sweating多汗paleskincoolskin皮膚涼rapidbreathing呼吸急促heav

15、ybreathing呼吸沉重rapidheartrate快心律congestedbreathingdisinterestinfeeding,ortiringwhilefeeding食欲差，或喂食的時候易疲勞poorweightgain體重增加緩慢Thesymptomsoftruncusarteriosusmayresembleothermedicalconditionsorheartproblems.Alwaysconsultyourchildsphysicianforadiagnosis.共同動脈干的癥候群可能與其它疾病或心臟問題相似。為了診斷總要請教你孩子的醫(yī)生。Howistruncusa

16、rteriosusdiagnosed?怎樣診斷共同動脈干？Yourchildsphysicianmayhaveheardaheartmurmurduringaphysicalexamination,andreferredyourchildtoapediatriccardiologistforadiagnosis.Aheartmurmurissimplyanoisecausedbytheturbulenceofbloodflowingthroughtheheartdefects.Symptomsyourchildexhibitswillalsohelpwiththediagnosis.在查體時你

17、孩子的醫(yī)生可能聽到心臟雜音，并把你孩子交付給一位小兒心臟病專家以明確診斷。心臟雜音是血流從左心室到升主動脈通過狹窄的主動脈瓣口時產(chǎn)生的湍流引起的噪音。你孩子表現(xiàn)出來的癥狀對于診斷也有幫助。Apediatriccardiologistspecializesinthediagnosisandmedicalmanagementofcongenitalheartdefects,aswellasheartproblemsthatmaydeveloplaterinchildhood.Thecardiologistwillperformaphysicalexamination,listeningtotheh

18、eartandlungs,andmakeotherobservationsthathelpinthediagnosis.Thelocationwithinthechestthatthemurmurisheardbest,aswellastheloudnessandqualityofthemurmur(harsh,blowing,etc.)willgivethecardiologistaninitialideaofwhichheartproblemyourchildmayhave.However,othertestsareneededtohelpwiththediagnosis,andmayin

19、cludethefollowing:一位兒童心臟病專家專門研究先天性心臟病的診斷和醫(yī)療方法，和隨后心臟問題在兒童期可能的發(fā)展。心臟專家將進(jìn)行體檢，聽診你的孩子的心和肺，作一些有助于診斷的觀測。在胸部雜音聽得最清楚的位置，以及雜音的響度和性質(zhì)（粗糙的，吹風(fēng)樣的，等等）對于你的孩子可能患有什么樣的心臟問題，將給心臟專家一個初步的意向。然而，有助于診斷的其他的一些檢查也是需要的，可能包括以下的檢查：chestx-ray-adiagnostictestwhichusesinvisibleelectromagneticenergybeamstoproduceimagesofinternaltissues

20、,bones,andorgansontofilm.胸部X線檢查：用一種看不見的電磁波投射在膠片上產(chǎn)生內(nèi)部組織，骨骼，和臟器的影像的診斷性的檢查。electrocardiogram(ECGorEKG)-atestthatrecordstheelectricalactivityoftheheart,showsabnormalrhythms(arrhythmiasordysrhythmias),anddetectsheartmusclestress.心電圖（ECG或EKG)：一種記錄心臟電活動的測試，可以顯示不正常的心律（arrhythmias或dysrhythmias),還可以發(fā)現(xiàn)心肌損害。ech

21、ocardiogram(echo)-aprocedurethatevaluatesthestructureandfunctionoftheheartbyusingsoundwavesrecordedonanelectronicsensorthatproduceamovingpictureoftheheartandheartvalves.超聲心動圖（echo)：一種通過把超聲波記錄在電子傳感器上再轉(zhuǎn)換成心臟和心臟瓣膜的活動影像來評價心臟的結(jié)構(gòu)和功能的方法。cardiaccatheterization-acardiaccatheterizationisaninvasiveprocedurethat

22、givesverydetailedinformationaboutthestructuresinsidetheheart.Undersedation,asmall,thin,flexibletube(catheter)isinsertedintoabloodvesselinthegroin,andguidedtotheinsideoftheheart.Bloodpressureandoxygenmeasurementsaretakeninthefourchambersoftheheart,aswellasthepulmonaryarteryandaorta.Contrastdyeisalsoi

23、njectedtomoreclearlyvisualizethestructuresinsidetheheart.心導(dǎo)管檢查：心導(dǎo)管檢查是一種侵入性的檢查，它能夠提供關(guān)于心內(nèi)結(jié)構(gòu)的很詳細(xì)的信息。在鎮(zhèn)靜狀態(tài)下，一條細(xì)小，壁薄，柔軟的管子（心導(dǎo)管）在腹股溝部位插入血管，并且引導(dǎo)進(jìn)入心內(nèi)。在心臟的四個腔里以及肺動脈和主動脈里分別測量血壓和血氧。也可以注入造影劑以便于更清楚的觀察心內(nèi)的結(jié)構(gòu)。Treatmentfortruncusarteriosus:共同動脈干的治療：Specifictreatmentfortruncusarteriosuswillbedeterminedbyyourchildsphy

24、sicianbasedon:共同動脈干的特殊治療將由你孩子的醫(yī)生根據(jù)以下幾點作出決定：yourchildsage,overallhealth,andmedicalhistoryextentoftheconditionyourchildstoleranceforspecificmedications,procedures,ortherapiesexpectationsforthecourseoftheconditionyouropinionorpreference你孩子的年齡，全面的健康情況，和病史。病的程度。你的孩子對于特殊的藥物，手術(shù)，或其他治療的耐受性。疾病過程的預(yù)后。你的意見或選擇。Tr

25、uncusarteriosusmustbetreatedbysurgicalrepairofthedefects.However,medicalsupportmaybenecessaryuntilthebesttimefortheoperationtotakeplace.Treatmentmayinclude:共同動脈干只有進(jìn)行外科手術(shù)治療.然而,藥物支持治療直到施行手術(shù)的最佳時機(jī)以前都是必要的,medicalmanagement醫(yī)療管理Manychildrenwilleventuallyneedtotakemedicationstohelptheheartandlungsworkbetter

26、.Medicationthatmaybeprescribedincludesthefollowing:多數(shù)患兒最終需要服用藥物來幫助他們的心和肺工作的好一些.處方的藥物可能包括以下:digoxin-amedicationthathelpsstrengthentheheartmuscle,enablingittopumpmoreefficiently.地高辛:一種增加心肌收縮力的藥物,能使心臟的泵血更有效.diuretics-thebodyswaterbalancecanbeaffectedwhentheheartisnotworkingaswellasitcould.Thesemedicati

27、onshelpthekidneysremoveexcessfluidfromthebody.利尿藥:在心臟不能正常工作時影響到身體的水平衡.這類藥物幫助腎臟從身體里排除過多的液體.ACE(angiotensin-convertingenzyme)inhibitors-dilatesthebloodvessels,makingiteasierforthehearttopumpbloodforwardintothebody.ACE(血管緊張素轉(zhuǎn)換酶)抑制劑:擴(kuò)張血管,使心臟向前泵血到全身容易一些.adequatenutritionInfantsmaybecometiredwhenfeeding,a

28、ndmaynotbeabletoeatenoughcaloriestogainweight.Optionsthatcanbeusedtoensureyourbabywillhaveadequatenutritioninclude:適當(dāng)?shù)臓I養(yǎng)：患嬰在喂奶時可能會很疲勞，不能夠吃驚足夠的熱量以增長體重。以下的選項可以用來保證你的寶貝將能夠獲得足夠的營養(yǎng)。high-calorieformulaorbreastmilkSpecialnutritionalsupplementsmaybeaddedtoformulaorpumpedbreastmilkthatincreasethenumberofcalo

29、riesineachounce,therebyallowingyourbabytodrinklessandstillconsumeenoughcaloriestogrow.高熱量配方或母乳：特殊的營養(yǎng)補(bǔ)充加入配方或抽取的母乳中，增加每一盎司中的卡路里的量。因此使你的寶貝雖然喝得少一點，依然能夠獲得正常生長所需要的足夠的卡路里。supplementaltubefeedingsFeedingsgiventhroughasmall,flexibletubethatpassesthroughthenose,downtheesophagus,andintothestomach,caneithersupp

30、lementortaketheplaceofbottlefeedings.Infantswhocandrinkpartoftheirbottle,butnotall,maybefedtheremainderthroughthefeedingtube.Infantswhoaretootiredtobottlefeedmayreceivetheirformulaorbreastmilkthroughthefeedingtubealone.鼻飼管喂養(yǎng)：通過一條細(xì)小的、柔軟的經(jīng)鼻插入沿食管下去進(jìn)入到胃的管子注入營養(yǎng)物質(zhì)，可以補(bǔ)充或代替奶瓶喂養(yǎng)。嬰兒可以用奶瓶喂一部分，但不是全部，剩下的部分經(jīng)鼻飼管喂入

31、。嬰兒如果太虛弱了尚不能使用奶瓶，可以把配方奶或母乳都只通過鼻飼管喂入。surgicalrepair手術(shù)矯治Surgeryisusuallyperformedaftertheinfantis2weeksold,butbeforethebloodvesselsinthelungsareoverwhelmedbyextrabloodflowandbecomediseased.通常在患嬰2周大時施行手術(shù)，但是要在肺內(nèi)血管被過多的血量損傷和出現(xiàn)病變以前。Theoperationisperformedundergeneralanesthesia,andinvolvesthefollowing:手術(shù)在全身

32、麻醉下進(jìn)行，包括以下的步驟：Thepulmonaryarteriesaredetachedfromthecommonartery(truncusarteriosus)andconnectedtotherightventricleusingahomograft(asectionofpulmonaryarterywithitsvalvesintactfromatissuedonor).把肺動脈從共同動脈干上分離下來，然后用同種移植物（從一個組織供體上取下來的帶有完整瓣膜的一段肺動脈）連接到右心室上，Theventricularseptaldefectisclosedwithapatch.用一個補(bǔ)片

33、把室間隔缺損補(bǔ)上。Postoperativecareforyourchild:為你孩子的手術(shù)后護(hù)理：Childrenwillspendtimeintheintensivecareunit(ICU)afteratruncusrepair.在共同動脈干矯治術(shù)后患兒將在監(jiān)護(hù)室里待上一段時間。WhileyourchildisintheICU,specialequipmentwillbeusedtohelphim/herrecover,andmayincludethefollowing:當(dāng)你的小孩在監(jiān)護(hù)室時，以下的特殊的設(shè)備將可能用來幫助他她康復(fù)。ventilator-amachinethathelps

34、yourchildbreathewhilehe/sheisunderanesthesiaduringtheoperation.Asmall,plastictubeisguidedintothewindpipeandattachedtotheventilator,whichbreathesforyourchildwhilehe/sheistoosleepytobreatheeffectivelyonhis/herown.Afteratruncusrepair,childrenwillbenefitfromremainingontheventilatorovernightorevenlongers

35、otheycanrest.呼吸機(jī)：一個當(dāng)你孩子在麻醉下手術(shù)時幫助他她呼吸的機(jī)器。一個細(xì)小的塑料管插入氣管并與呼吸機(jī)連接，當(dāng)你的孩子沉睡不能自己有效地呼吸時，它給你的小孩通氣。共同動脈干矯治術(shù)后患兒持續(xù)使用呼吸機(jī)過夜或者甚至更長一點將是有益的，因此他們可以得到休息。intravenous(IV)catheters-small,plastictubesinsertedthroughtheskinintobloodvesselstoprovideIVfluidsandimportantmedicinesthathelpyourchildrecoverfromtheoperation.靜脈內(nèi)（IV）導(dǎo)

36、管：一條細(xì)小的塑料管經(jīng)過皮膚插入血管，輸注需要的靜脈液體和重要的藥物，以幫助你的孩子手術(shù)后康復(fù)。arterialline-aspecializedIVplacedinthewristorotherareaofthebodywhereapulsecanbefelt,thatmeasuresbloodpressurecontinuouslyduringsurgeryandwhileyourchildisintheICU.動脈管：一個專門的動脈內(nèi)小插管，安置在腕部或身體其他可以觸到脈搏的地方，當(dāng)你的小孩在手術(shù)期間或在ICU里時用來連續(xù)測量血壓。nasogastric(NG)tube-asmall,f

37、lexibletubethatkeepsthestomachdrainedofacidandgasbubblesthatmaybuildupduringsurgery.鼻胃（NG)管：一個細(xì)小的，柔軟的管子，用來持續(xù)排空胃內(nèi)在手術(shù)期間可能聚集的胃酸和氣體。urinarycatheter-asmall,flexibletubethatallowsurinetodrainoutofthebladderandaccuratelymeasureshowmuchurinethebodymakes,whichhelpsdeterminehowwelltheheartisfunctioning.Afters

38、urgery,theheartwillbealittleweakerthanitwasbefore,and,therefore,thebodymaystarttoholdontofluid,causingswellingandpuffiness.Diureticsmaybegiventohelpthekidneystoremoveexcessfluidfromthebody.導(dǎo)尿管：一個細(xì)小的，柔軟的管子從膀胱引流尿液并且精確的測量機(jī)體產(chǎn)生了多少尿液，這對于判斷心功能如何有幫助。在手術(shù)后，心臟比以前會有一點虛弱，并且，因此，機(jī)體可能開始保持液體，引起水腫和虛胖?？赡軙o與利尿藥以幫助腎臟從身體

39、里排出過多的液體。chesttube-adrainagetubemaybeinsertedtokeepthechestfreeofbloodthatwouldotherwiseaccumulateaftertheincisionisclosed.Bleedingmayoccurforseveralhours,orevenafewdaysaftersurgery.胸管：一根胸腔引流管保持切口縫合以后胸腔里沒有積血。出血可能發(fā)生在術(shù)后數(shù)小時或甚至幾天。heartmonitor-amachinethatconstantlydisplaysapictureofyourchildsheartrhythm

40、,andmonitorsheartrate,arterialbloodpressure,andothervalues.心臟監(jiān)視器：一個機(jī)器持續(xù)的顯示你孩子的心律的圖形，并且監(jiān)視心率，動脈血壓，和其它的數(shù)值。YourchildmayneedotherequipmentnotmentionedheretoprovidesupportwhileintheICU,orafterwards.Thehospitalstaffwillexplainallofthenecessaryequipmenttoyou.當(dāng)你的小孩在ICU里時或者隨后可能需要這里沒有提到的設(shè)備提供支持。醫(yī)院的職員將向你說明所有的這些必

41、需的設(shè)備。Yourchildwillbekeptascomfortableaspossiblewithseveraldifferentmedications;somewhichrelievepain,andsomewhichrelieveanxiety.Thestaffwillalsobeaskingforyourinputastohowbesttosootheandcomfortyourchild.使用幾種不同的藥物治療，將使你的孩子盡可能的保持舒適；有的止痛，有的解除焦慮。職員將會告訴你怎樣最好的使你的孩子安靜和舒適。AfterdischargedfromtheICU,yourchildw

42、illrecuperateonanotherhospitalunitforafewdaysbeforegoinghome.Youwilllearnhowtocareforyourchildathomebeforeyourchildisdischarged.Yourchildmayneedtotakemedicationsforawhileathome,andthesewillbeexplainedtoyou.Thestaffwillgiveyouinstructionsregardingmedications,activitylimitations,andfollow-upappointmen

43、tsbeforeyourchildisdischarged.從ICU轉(zhuǎn)出之后，在回家之前你的孩子要在醫(yī)院的另一個單元里恢復(fù)幾天。在你的孩子出院之前，你將要學(xué)習(xí)在家里怎樣照顧你的孩子。你的孩子在家期間可能需要服藥，我們將把這些向你解釋。在你的孩子出院之前，職員將給你關(guān)于藥物治療，活動限制，和隨訪約定的指導(dǎo)。Caringforyourchildathomefollowingtruncusarteriosusrepair:你孩子在共同動脈干矯治手術(shù)后的家庭護(hù)理：Painmedications,suchasacetaminophenoribuprofen,mayberecommendedtokeepyourchildcomfortableathome.Yourchildsphysicianwilldiscusspaincontrolbeforeyourchildisdischargedfromthehospital.止痛藥，比如醋氨酚或布洛芬，可以保持你的孩子比較舒服的待在家里。在出院之前你孩子的醫(yī)生將會講述疼痛的控制。Often,infantswhofedpoorlypriortosurgeryhavemoreenergyaftertherecuperation