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首页> 外文期刊>Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual >Pediatric Cardiac Surgery: A Challenge and Outcome Analysis of the Guatemala Effort
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Pediatric Cardiac Surgery: A Challenge and Outcome Analysis of the Guatemala Effort

机译：小儿心脏外科：危地马拉努力的挑战和结果分析

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A large underserved population of children with congenital cardiac malformation (CCM) exists in many developing countries. In recent years, several strategies have been implemented to supplement this need. These strategies include transferring children to first-world countries for surgical care or the creation of local pediatric cardiovascular surgical programs. In 1997, an effort was made to create a comprehensive pediatric cardiac care program in Guatemala. The objective of this study is to examine the outcome analysis of the Guatemala effort. The goals of our new and first pediatric cardiac care program were to: 1) provide diagnosis and treatment to all children with a CCM in Guatemala; 2) train of local staff surgeons, 3) established a foundation locally and in the United States in 1997 to serve as a fundraising instrument to acquire equipment and remodeling of the pediatric cardiac unit and also to raise funds to pay the hospital for the almost exclusively poor pediatric cardiac patients. The staff now includes 3 surgeons from Guatemala, trained by the senior surgeon (A.R.C.), seven pediatric cardiologists, 3 intensivists, and 2 anesthesiologists, as well as intensive care and ward nurses, respiratory therapists, echocardiography technicians, and support personnel. The cardiovascular program expanded in 2005 to 2 cardiac operating rooms, 1 cardiac catheterization laboratory, 1 cardiac echo lab, 4 outpatients clinics a 6-bed intensive care unit and a 4-bed stepdown unit, a 20 bed general ward (2 beds/room) and a genetics laboratory. Our center has become a referral center for children from Central America. A total of 2,630 surgical procedures were performed between February 1997 and December 2007, increasing the number of operations each year. Postoperative complication occurred in 523 of 2,630 procedures (20%). A late follow-up study was conducted of all the patients operated from 1997 to 2005. Late mortality was 2.7%. Development of a sustainable pediatric cardiac program in emerging countries presents many difficult challenges. Hard work, perseverance, adaptability, and tolerance are useful aptitudes to develop a viable PCP in an "emerging" country. We are not in favor of Medical-Surgical Safari efforts, unless these efforts include training of a local team and eventual unit independence. It helps if an experienced (? senior/retired!) surgeon leads this effort on a full-time, pro bono basis. Local and international fund raising is essential to complement vastly insufficient government subsidies.
机译：许多发展中国家存在大量服务不足的先天性心脏畸形（CCM）儿童。近年来，已经实施了几种策略来补充这种需求。这些策略包括将儿童转移到第一世界国家进行外科手术治疗，或创建当地的儿科心血管外科手术计划。 1997年，努力在危地马拉制定了全面的儿科心脏保健计划。这项研究的目的是检查危地马拉努力的成果分析。我们新的和第一个儿科心脏保健计划的目标是：1）在危地马拉为所有患有CCM的儿童提供诊断和治疗; 2）培训当地医务人员的外科医生，3）1997年在美国本地和美国建立了基金会，作为筹款工具来购置小儿心脏单元的设备和改型，并筹集资金以支付医院几乎全部的费用小儿心脏疾病患者。现在，工作人员包括3名来自危地马拉的外科医师，他们由高级外科医师（A.R.C.）培训，7名儿科心脏病学家，3名强化医生和2名麻醉师，以及重症监护和病房护士，呼吸治疗师，超声心动图技术人员和支持人员。 2005年，心血管计划扩大到2个心脏手术室，1个心脏导管实验室，1个心脏回声实验室，4个门诊诊所，一个6张病床的重症监护病房和一个4张病床的降级病房，一个20张病床的普通病房（每病房2张病床） ）和遗传学实验室。我们的中心已成为中美洲儿童的推荐中心。在1997年2月至2007年12月之间，总共进行了2,630例外科手术，从而每年增加了手术次数。术后并发症发生在2,630例手术中的523例（20％）。对1997年至2005年所有手术患者进行了晚期随访研究。晚期死亡率为2.7％。新兴国家制定可持续的儿科心脏计划提出了许多困难的挑战。艰苦的工作，毅力，适应性和宽容是在“新兴”国家发展可行的PCP的有用才能。我们不赞成Safari野生医学的努力，除非这些努力包括对当地团队的培训和最终的单位独立性。如果经验丰富的（？高级/退休！）外科医生全职，无偿地领导这项工作，将会很有帮助。地方和国际筹资对补充政府补贴不足十分重要。

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