TruncusArteriosus共同动脉干电子教案

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

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

3、curswhenthesinglegreatvesselfailstoseparatecompletely,leavingaconnectionbetweentheaortaandpulmonaryartery.共同动脉干是一种先天性心脏病(出生时即有的)是由于在妊娠的头8周里胎儿心脏发育异常造成的。心脏开始是一个中空管，并且心腔、瓣膜、和大血管的发育贯穿这妊娠的头8周。主动脉和肺动脉在开始时是一个血管，以后分隔成两个动脉。当这个大血管没有完全分开时，在主动脉和肺动脉之间留下连接处。Truncusarteriosisisacomplexdefectwherethereisasingle(nor

4、mallytherearetwoseparatearteries)vesselarisingfromtheheartthatformstheaortaandpulmonaryartery.Anothercongenitalheartdefectthatoccurswithtruncusarteriosusisaventricularseptaldefect(ventricularseptum,ordividingwallbetweenthetwolowerchambersoftheheartknownastherightandleftventricles).共同动脉干是一种复杂的缺陷，一个单一

5、的血管从心脏发出，（正常时是两个互相分开的动脉）。与共同动脉干相伴的另外的心脏缺损是心室间隔缺损。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.正常时，这儿是两个互相分开的动脉（主动脉和肺动脉。静脉血（兰）从全身回到右心房，进入右心室，然后泵出经肺动脉进入肺，在这里吸收氧。动脉血（红）从肺里回到左心房，进入左心室，然后泵出经主

7、动脉到达全身）。Intruncusarteriosus,oxygen-poor(blue)andoxygen-rich(red)bloodmixbackandforththroughtheventricularseptaldefect.Thismixedbloodthenflowsthroughthecommontruncalvessel.Someofitwillflowthroughthebranchthatbecomesthepulmonaryarteryandontothelungs,andsomeofthemixedbloodwillgointotheaorticbranchandco

8、ntinuetothebody.Themixedbloodthatgoestothebodydoesnothaveasmuchoxygenasnormal,andwillcausevaryingdegreesofcyanosis(bluecoloroftheskin,lips,andnailbeds).在共同动脉干的病例，贫氧血（兰）和富氧血（红）经过室间隔缺损来回的混合，然后这混合的血液经过这共同的血管，一部分进入成为肺动脉的分支到达肺里，而另一部分则进入主动脉的分支继续流到全身。混合的血没有带上正常的那么多的氧到达全身，就会引起不同程度的紫绀。（皮肤、口唇、和甲床呈蓝色）Truncusar

9、teriosusoccursinlessthanoneoutofevery10,000livebirths.Itmakesup1percentofallcasesofcongenitalheartdisease.共同动脉干的发生在每一万新生儿中少于一个。在所有的先天性心脏病中达1。Whatcausestruncusarteriosus?什么引起共同动脉干？Somecongenitalheartdefectsmayhaveageneticlink,eitheroccurringduetoadefectinagene,achromosomeabnormality,orenvironmentalex

10、posure,causingheartproblemstooccurmoreoftenincertainfamilies.Othertimesthisheartdefectoccurssporadically(bychance),withnoclearreasonforitsdevelopment.某些先天性心脏病可能带有遗传链接，由于基因缺陷，染色体异常，或环境暴露，任何一项引起心脏问题较常发生在某些家庭。其他情况下，心脏病的发生是偶然的，对于它的发展没有明确的原因。Whyistruncusarteriosusaconcern?为什么关注共同动脉干？Thebloodthatpassesthr

11、oughthecommontruncalvesselhasaloweroxygencontentthannormal.Oxygen-poor(blue)bloodfromtherightventricleandoxygen-rich(red)bloodfromtheleftventriclemixtogetherbeforeenteringthecommonvessel.Someofthismixedbloodwillgointotheaortaandontothebody,producingcyanosis(bluecoloroftheskin,lips,andnailbeds).通过共同动

12、脉的血流的含氧量较正常的低。在进入共同血管之前，来自右心室的贫氧血（兰）和来自左心室的富氧血（红）混合在一起。这混合血的一部分进入主动脉供应全身，产生紫绀（皮肤、口唇、和甲床呈蓝色）。Thepulmonaryarterysectionofthecommonvesselgetsmorebloodflowthantheaortadoes,becausethepressureislowerinthelungsthanthebodyanditiseasierforbloodtotravelinthatdirection.Ifnotrepaired,thebloodvesselsinthelungsbe

13、comedamagedbytheextrabloodflow.Asthepressureinthebloodvesselsinthelungsbecomeshigher,lessbloodgoestothelungsandmoregoestothebody.Cyanosisbecomesworseasbloodwithloweramountsofoxygentravelstothebody.这共同血管的肺动脉部分得到比主动脉多的血液，因为肺的压力比全身的压力低，所以血液容易流入。如果不矫治，肺内的血管就会被过多的血流损伤。随着肺内血管的压力增高，到肺的血减少而到全身的血增加。随着到全身的血液携

14、带的氧量的减少，紫绀变得更严重。Whatarethesymptomsoftruncusarteriosus?TA有什么症侯群？Thefollowingarethemostcommonsymptomsoftruncusarteriosus.However,eachchildmayexperiencesymptomsdifferently.Symptomsmayinclude:以下是TA最常见的症侯群。然而，每一个患儿可能经历的症侯群有所不同。症候群可能包括：cyanosis紫绀fatigue疲劳sweating多汗paleskincoolskin皮肤凉rapidbreathing呼吸急促heav

15、ybreathing呼吸沉重rapidheartrate快心律congestedbreathingdisinterestinfeeding,ortiringwhilefeeding食欲差，或喂食的时候易疲劳poorweightgain体重增加缓慢Thesymptomsoftruncusarteriosusmayresembleothermedicalconditionsorheartproblems.Alwaysconsultyourchildsphysicianforadiagnosis.共同动脉干的症候群可能与其它疾病或心脏问题相似。为了诊断总要请教你孩子的医生。Howistruncusa

16、rteriosusdiagnosed?怎样诊断共同动脉干？Yourchildsphysicianmayhaveheardaheartmurmurduringaphysicalexamination,andreferredyourchildtoapediatriccardiologistforadiagnosis.Aheartmurmurissimplyanoisecausedbytheturbulenceofbloodflowingthroughtheheartdefects.Symptomsyourchildexhibitswillalsohelpwiththediagnosis.在查体时你

17、孩子的医生可能听到心脏杂音，并把你孩子交付给一位小儿心脏病专家以明确诊断。心脏杂音是血流从左心室到升主动脉通过狭窄的主动脉瓣口时产生的湍流引起的噪音。你孩子表现出来的症状对于诊断也有帮助。Apediatriccardiologistspecializesinthediagnosisandmedicalmanagementofcongenitalheartdefects,aswellasheartproblemsthatmaydeveloplaterinchildhood.Thecardiologistwillperformaphysicalexamination,listeningtotheh

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

19、cludethefollowing:一位儿童心脏病专家专门研究先天性心脏病的诊断和医疗方法，和随后心脏问题在儿童期可能的发展。心脏专家将进行体检，听诊你的孩子的心和肺，作一些有助于诊断的观测。在胸部杂音听得最清楚的位置，以及杂音的响度和性质（粗糙的，吹风样的，等等）对于你的孩子可能患有什么样的心脏问题，将给心脏专家一个初步的意向。然而，有助于诊断的其他的一些检查也是需要的，可能包括以下的检查：chestx-ray-adiagnostictestwhichusesinvisibleelectromagneticenergybeamstoproduceimagesofinternaltissues

20、,bones,andorgansontofilm.胸部X线检查：用一种看不见的电磁波投射在胶片上产生内部组织，骨骼，和脏器的影像的诊断性的检查。electrocardiogram(ECGorEKG)-atestthatrecordstheelectricalactivityoftheheart,showsabnormalrhythms(arrhythmiasordysrhythmias),anddetectsheartmusclestress.心电图（ECG或EKG)：一种记录心脏电活动的测试，可以显示不正常的心律（arrhythmias或dysrhythmias),还可以发现心肌损害。ech

21、ocardiogram(echo)-aprocedurethatevaluatesthestructureandfunctionoftheheartbyusingsoundwavesrecordedonanelectronicsensorthatproduceamovingpictureoftheheartandheartvalves.超声心动图（echo)：一种通过把超声波记录在电子传感器上再转换成心脏和心脏瓣膜的活动影像来评价心脏的结构和功能的方法。cardiaccatheterization-acardiaccatheterizationisaninvasiveprocedurethat

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

23、njectedtomoreclearlyvisualizethestructuresinsidetheheart.心导管检查：心导管检查是一种侵入性的检查，它能够提供关于心内结构的很详细的信息。在镇静状态下，一条细小，壁薄，柔软的管子（心导管）在腹股沟部位插入血管，并且引导进入心内。在心脏的四个腔里以及肺动脉和主动脉里分别测量血压和血氧。也可以注入造影剂以便于更清楚的观察心内的结构。Treatmentfortruncusarteriosus:共同动脉干的治疗：Specifictreatmentfortruncusarteriosuswillbedeterminedbyyourchildsphy

24、sicianbasedon:共同动脉干的特殊治疗将由你孩子的医生根据以下几点作出决定：yourchildsage,overallhealth,andmedicalhistoryextentoftheconditionyourchildstoleranceforspecificmedications,procedures,ortherapiesexpectationsforthecourseoftheconditionyouropinionorpreference你孩子的年龄，全面的健康情况，和病史。病的程度。你的孩子对于特殊的药物，手术，或其他治疗的耐受性。疾病过程的预后。你的意见或选择。Tr

25、uncusarteriosusmustbetreatedbysurgicalrepairofthedefects.However,medicalsupportmaybenecessaryuntilthebesttimefortheoperationtotakeplace.Treatmentmayinclude:共同动脉干只有进行外科手术治疗.然而,药物支持治疗直到施行手术的最佳时机以前都是必要的,medicalmanagement医疗管理Manychildrenwilleventuallyneedtotakemedicationstohelptheheartandlungsworkbetter

26、.Medicationthatmaybeprescribedincludesthefollowing:多数患儿最终需要服用药物来帮助他们的心和肺工作的好一些.处方的药物可能包括以下:digoxin-amedicationthathelpsstrengthentheheartmuscle,enablingittopumpmoreefficiently.地高辛:一种增加心肌收缩力的药物,能使心脏的泵血更有效.diuretics-thebodyswaterbalancecanbeaffectedwhentheheartisnotworkingaswellasitcould.Thesemedicati

27、onshelpthekidneysremoveexcessfluidfromthebody.利尿药:在心脏不能正常工作时影响到身体的水平衡.这类药物帮助肾脏从身体里排除过多的液体.ACE(angiotensin-convertingenzyme)inhibitors-dilatesthebloodvessels,makingiteasierforthehearttopumpbloodforwardintothebody.ACE(血管紧张素转换酶)抑制剂:扩张血管,使心脏向前泵血到全身容易一些.adequatenutritionInfantsmaybecometiredwhenfeeding,a

28、ndmaynotbeabletoeatenoughcaloriestogainweight.Optionsthatcanbeusedtoensureyourbabywillhaveadequatenutritioninclude:适当的营养：患婴在喂奶时可能会很疲劳，不能够吃惊足够的热量以增长体重。以下的选项可以用来保证你的宝贝将能够获得足够的营养。high-calorieformulaorbreastmilkSpecialnutritionalsupplementsmaybeaddedtoformulaorpumpedbreastmilkthatincreasethenumberofcalo

29、riesineachounce,therebyallowingyourbabytodrinklessandstillconsumeenoughcaloriestogrow.高热量配方或母乳：特殊的营养补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。因此使你的宝贝虽然喝得少一点，依然能够获得正常生长所需要的足够的卡路里。supplementaltubefeedingsFeedingsgiventhroughasmall,flexibletubethatpassesthroughthenose,downtheesophagus,andintothestomach,caneithersupp

30、lementortaketheplaceofbottlefeedings.Infantswhocandrinkpartoftheirbottle,butnotall,maybefedtheremainderthroughthefeedingtube.Infantswhoaretootiredtobottlefeedmayreceivetheirformulaorbreastmilkthroughthefeedingtubealone.鼻饲管喂养：通过一条细小的、柔软的经鼻插入沿食管下去进入到胃的管子注入营养物质，可以补充或代替奶瓶喂养。婴儿可以用奶瓶喂一部分，但不是全部，剩下的部分经鼻饲管喂入

31、。婴儿如果太虚弱了尚不能使用奶瓶，可以把配方奶或母乳都只通过鼻饲管喂入。surgicalrepair手术矫治Surgeryisusuallyperformedaftertheinfantis2weeksold,butbeforethebloodvesselsinthelungsareoverwhelmedbyextrabloodflowandbecomediseased.通常在患婴2周大时施行手术，但是要在肺内血管被过多的血量损伤和出现病变以前。Theoperationisperformedundergeneralanesthesia,andinvolvesthefollowing:手术在全身

32、麻醉下进行，包括以下的步骤：Thepulmonaryarteriesaredetachedfromthecommonartery(truncusarteriosus)andconnectedtotherightventricleusingahomograft(asectionofpulmonaryarterywithitsvalvesintactfromatissuedonor).把肺动脉从共同动脉干上分离下来，然后用同种移植物（从一个组织供体上取下来的带有完整瓣膜的一段肺动脉）连接到右心室上，Theventricularseptaldefectisclosedwithapatch.用一个补片

33、把室间隔缺损补上。Postoperativecareforyourchild:为你孩子的手术后护理：Childrenwillspendtimeintheintensivecareunit(ICU)afteratruncusrepair.在共同动脉干矫治术后患儿将在监护室里待上一段时间。WhileyourchildisintheICU,specialequipmentwillbeusedtohelphim/herrecover,andmayincludethefollowing:当你的小孩在监护室时，以下的特殊的设备将可能用来帮助他她康复。ventilator-amachinethathelps

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

35、otheycanrest.呼吸机：一个当你孩子在麻醉下手术时帮助他她呼吸的机器。一个细小的塑料管插入气管并与呼吸机连接，当你的孩子沉睡不能自己有效地呼吸时，它给你的小孩通气。共同动脉干矫治术后患儿持续使用呼吸机过夜或者甚至更长一点将是有益的，因此他们可以得到休息。intravenous(IV)catheters-small,plastictubesinsertedthroughtheskinintobloodvesselstoprovideIVfluidsandimportantmedicinesthathelpyourchildrecoverfromtheoperation.静脉内（IV）导

36、管：一条细小的塑料管经过皮肤插入血管，输注需要的静脉液体和重要的药物，以帮助你的孩子手术后康复。arterialline-aspecializedIVplacedinthewristorotherareaofthebodywhereapulsecanbefelt,thatmeasuresbloodpressurecontinuouslyduringsurgeryandwhileyourchildisintheICU.动脉管：一个专门的动脉内小插管，安置在腕部或身体其他可以触到脉搏的地方，当你的小孩在手术期间或在ICU里时用来连续测量血压。nasogastric(NG)tube-asmall,f

37、lexibletubethatkeepsthestomachdrainedofacidandgasbubblesthatmaybuildupduringsurgery.鼻胃（NG)管：一个细小的，柔软的管子，用来持续排空胃内在手术期间可能聚集的胃酸和气体。urinarycatheter-asmall,flexibletubethatallowsurinetodrainoutofthebladderandaccuratelymeasureshowmuchurinethebodymakes,whichhelpsdeterminehowwelltheheartisfunctioning.Afters

38、urgery,theheartwillbealittleweakerthanitwasbefore,and,therefore,thebodymaystarttoholdontofluid,causingswellingandpuffiness.Diureticsmaybegiventohelpthekidneystoremoveexcessfluidfromthebody.导尿管：一个细小的，柔软的管子从膀胱引流尿液并且精确的测量机体产生了多少尿液，这对于判断心功能如何有帮助。在手术后，心脏比以前会有一点虚弱，并且，因此，机体可能开始保持液体，引起水肿和虚胖。可能会给与利尿药以帮助肾脏从身体

39、里排出过多的液体。chesttube-adrainagetubemaybeinsertedtokeepthechestfreeofbloodthatwouldotherwiseaccumulateaftertheincisionisclosed.Bleedingmayoccurforseveralhours,orevenafewdaysaftersurgery.胸管：一根胸腔引流管保持切口缝合以后胸腔里没有积血。出血可能发生在术后数小时或甚至几天。heartmonitor-amachinethatconstantlydisplaysapictureofyourchildsheartrhythm

40、,andmonitorsheartrate,arterialbloodpressure,andothervalues.心脏监视器：一个机器持续的显示你孩子的心律的图形，并且监视心率，动脉血压，和其它的数值。YourchildmayneedotherequipmentnotmentionedheretoprovidesupportwhileintheICU,orafterwards.Thehospitalstaffwillexplainallofthenecessaryequipmenttoyou.当你的小孩在ICU里时或者随后可能需要这里没有提到的设备提供支持。医院的职员将向你说明所有的这些必

41、需的设备。Yourchildwillbekeptascomfortableaspossiblewithseveraldifferentmedications;somewhichrelievepain,andsomewhichrelieveanxiety.Thestaffwillalsobeaskingforyourinputastohowbesttosootheandcomfortyourchild.使用几种不同的药物治疗，将使你的孩子尽可能的保持舒适；有的止痛，有的解除焦虑。职员将会告诉你怎样最好的使你的孩子安静和舒适。AfterdischargedfromtheICU,yourchildw

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

43、tsbeforeyourchildisdischarged.从ICU转出之后，在回家之前你的孩子要在医院的另一个单元里恢复几天。在你的孩子出院之前，你将要学习在家里怎样照顾你的孩子。你的孩子在家期间可能需要服药，我们将把这些向你解释。在你的孩子出院之前，职员将给你关于药物治疗，活动限制，和随访约定的指导。Caringforyourchildathomefollowingtruncusarteriosusrepair:你孩子在共同动脉干矫治手术后的家庭护理：Painmedications,suchasacetaminophenoribuprofen,mayberecommendedtokeepyourchildcomfortableathome.Yourchildsphysicianwilldiscusspaincontrolbeforeyourchildisdischargedfromthehospital.止痛药，比如醋氨酚或布洛芬，可以保持你的孩子比较舒服的待在家里。在出院之前你孩子的医生将会讲述疼痛的控制。Often,infantswhofedpoorlypriortosurgeryhavemoreenergyaftertherecuperation