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首页> 外文期刊>The American Journal of Cardiology >Specialized delivery room planning for fetuses with critical congenital heart disease
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Specialized delivery room planning for fetuses with critical congenital heart disease

机译：重症先天性心脏病胎儿的专业分娩室计划

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Improvements in fetal echocardiography have increased recognition of fetuses with congenital heart disease (CHD) that require specialized delivery room (DR) care. In this study, care protocols for these low-volume and high-risk deliveries were created. Elements included (1) diagnosis-specific DR care plans and algorithms, (2) a multidisciplinary team with expertise, (3) simulation, (4) checklists, and (5) debriefing. The purpose of this study was to assess the accuracy of fetal echocardiography to predict the need for specialized DR care and determine the effectiveness of the care protocols for the treatment of patients with critical CHD. Fetal and postnatal medical records and echocardiograms of fetuses with CHD assigned to an advanced level of care were reviewed. Safety and outcome variables were analyzed to determine care plan and algorithm efficacy. Thirty-four fetuses were identified: 12 delivered at Children's National Medical Center and 22 at the adult hospital. Diagnoses included hypoplastic left heart syndrome, aortic stenosis, d-transposition of the great arteries, tetralogy of Fallot with absent pulmonary valve, complex pulmonary atresia, arrhythmias, ectopia cordis, and conjoined twins. Delivery at Children's National Medical Center was associated with a shorter time to specialty care or intervention. Measures of physiologic stability and survival were similar. Need for specialized care was predicted in 84% of deliveries. For hypoplastic left heart syndrome, intervention was predicted in 10 of 11 deliveries and for d-transposition of the great arteries in 10 of 12 deliveries. Care algorithms addressed most DR events. Of the unanticipated events, none were unrecoverable. DR survival was 100%, and survival to discharge was 83%. In conclusion, fetal echocardiography predicted the need for specialized DR care in fetuses with critical CHD. Algorithm-driven protocols enable planning such that maternal and infant risk is minimized and outcomes are good. ? 2013 Elsevier Inc. All rights reserved.
机译：胎儿超声心动图的改善已提高了对先天性心脏病（CHD）的胎儿的认识，这些胎儿需要专门的产房（DR）护理。在这项研究中，创建了针对这些小批量和高风险分娩的护理方案。内容包括（1）诊断特定的DR护理计划和算法，（2）具有专业知识的多学科团队，（3）模拟，（4）清单和（5）汇报。这项研究的目的是评估胎儿超声心动图的准确性，以预测对专门的DR护理的需求，并确定该护理方案对重症CHD患者的治疗效果。回顾了CHD被指定为高级护理的胎儿的胎儿和产后医学记录以及超声心动图。分析安全性和结果变量，以确定护理计划和算法功效。共鉴定出34例胎儿：12例在儿童国家医疗中心分娩，22例在成人医院分娩。诊断包括左心发育不全综合征，主动脉瓣狭窄，大动脉d移位，无肺动脉瓣的法洛四联症，复杂的肺动脉闭锁，心​​律不齐，扩张性腹股沟和双胞胎。儿童国家医疗中心的分娩与专科护理或干预时间较短有关。生理稳定性和存活率的测量方法相似。预计有84％的分娩需要专业护理。对于发育不良的左心综合征，预计11例分娩中有10例会介入，12例分娩中有10例会发生大动脉的d移位。护理算法解决了大多数DR事件。在意外事件中，没有一个是无法恢复的。 DR生存率为100％，出院生存率为83％。总之，胎儿超声心动图预示了重症冠心病胎儿需要专门的DR护理。由算法驱动的协议可以进行计划，以使孕妇和婴儿的风险降到最低，并取得良好的效果。 ？ 2013 Elsevier Inc.保留所有权利。

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