[求助室间隔缺损（膜周型）

pyxrdb

<p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">&nbsp;<p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">尊敬的专家：<span lang="EN-US"><p></p></span></span></p><p style="TEXT-JUSTIFY: inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; TEXT-ALIGN: justify; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; mso-bidi-font-size: 12.0pt;"><font face="宋体">您好。<span style="COLOR: black;">我女儿<span lang="EN-US">4月19日出生，出生体重3.35公斤；现在两个多月，体重5公斤。出生第8天后，因黄疸在县人民医院治疗，请儿科医师会诊时听到心脏有杂音，心脏彩超检查发现室间隔缺损，大体内容为：<p></p></span></span></font></span></p><p style="TEXT-JUSTIFY: inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; TEXT-ALIGN: justify; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">（<span lang="EN-US">1）在室间隔隔瓣下处有一个0.2cm的缺损，可探及2.1M/s的由左到右分流信号，PG 18.2mmhg；<p></p></span></font></span></p><p style="TEXT-JUSTIFY: inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; TEXT-ALIGN: justify; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">（<span lang="EN-US">2）房间隔卵圆孔处未闭，可探及由左到右的分流信号；<p></p></span></font></span></p><p style="TEXT-JUSTIFY: inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; TEXT-ALIGN: justify; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">（<span lang="EN-US">3）在三尖瓣区探及收缩期1.5M/s的返流信号；<p></p></span></font></span></p><p style="TEXT-JUSTIFY: inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; TEXT-ALIGN: justify; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">其余瓣膜正常，心脏各房室腔大小正常。<span lang="EN-US"><p></p></span></font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">&nbsp;<p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-line-height-alt: 12.0pt; mso-char-indent-count: 2.0; mso-char-indent-size: 16.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">6月23日，宝宝66天时，到山东省省立医院<span style="COLOR: black;">进行了复查，</span>心脏超声诊断报告单如下： <p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">AO: 0.96 cm<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LA: 1.56 cm<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>RV: 0.84 cm<p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">IVS: 0.30 cm<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LV: 2.29 cm<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LVPW: 0.32 cm<p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 80pt; TEXT-INDENT: -80pt; mso-line-height-alt: 12.0pt; mso-char-indent-count: -5.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">超声描述：<span style="COLOR: black;">各房室腔内径正常。房间隔连续完整。室间隔上段</span>膜周部见一回声中断，基底部约<span lang="EN-US">0.36cm , 缺损右室面见少量膜样组织粘连。各段心肌厚度、回声、动度正常。各组<span style="COLOR: black;">瓣膜形态、</span>回声未见异常。<p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">CDFI：室间隔缺损<span style="COLOR: black;">处</span>见<span style="COLOR: black;">左向右分流信号，分流束受</span>膜样组织阻挡致使出口略变窄，出口<span style="COLOR: black;">内径约0.25cm ，CW测 Vmax: 413cm/s , PGmax: 68.2 mmHg 。<p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">超声提示：先天性心脏病<span lang="EN-US"><p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 119.25pt; mso-line-height-alt: 12.0pt;"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">室间隔缺损（膜周型）<span lang="EN-US"><p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; mso-line-height-alt: 12.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">请问：<span lang="EN-US">(1)</span></span><span lang="EN-US" style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;"> 山东省立医院的检查结果是否表明有<span style="COLOR: black;">自愈的倾向</span>；<p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 48pt; mso-line-height-alt: 12.0pt; mso-char-indent-count: 3.0; mso-char-indent-size: 16.0pt;"><span lang="EN-US" style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">(2)自行愈合的几率大不大，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">省立医院的医生说分流速度快（<span lang="EN-US" style="COLOR: black;">CW测 Vmax: 413cm/s , PGmax: 68.2 mmHg）不容易愈合，而有的资料上说自行愈合的机理就是在血流速度的作用下形成的；<p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 48pt; mso-line-height-alt: 12.0pt; mso-char-indent-count: 3.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">（<span lang="EN-US">3）观察期间，能不能接种疫苗（有的资料上说心脏病患儿不能打白百破三联针）。<p></p></span></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 48pt; mso-line-height-alt: 12.0pt; mso-char-indent-count: 3.0; mso-char-indent-size: 16.0pt;"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">恳请答复，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">不胜感激。<span lang="EN-US"><p></p></span></span></p>

陆医生

您好：<br/>&nbsp;&nbsp;&nbsp;&nbsp;缺损不大，建议继续定期复查，目前还看不出自愈倾向；<br/>&nbsp;&nbsp;&nbsp;&nbsp;可以预防接种。

pyxrdb

<p align="left"><font size="3">多谢<font face="宋体">专家</font>答复。还请问：</font></p><p align="left"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">&nbsp; （<span lang="EN-US">1）缺损会不会随着心脏的发育而变大（当地县医院的检查结果为“室间隔隔瓣下处有一个<font color="#dd2222">0.2cm</font>的缺损”；山东省省立医院的<span style="COLOR: black;">复查结果为“室间隔上段膜周部见一回声中断，基底部约<span lang="EN-US"><font color="#cc3333">0.36cm</font>
                                                </span>”。也可能是县级医院的检查结果不够精确吧</span>）。</span></font></span></p><p align="left"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">&nbsp; （<span lang="EN-US">2）在山东省省立医院<span style="COLOR: black;">进行复查时，做心脏超声检查的医生说缺损处长了一点（“基底部约<span lang="EN-US">0.36cm ,出口<span style="COLOR: black;">内径约0.25cm”；</span></span>“基底部”和“出口<span style="COLOR: black;">内径”数值之差是不是就是长的那部分。）</span></span></span></font></span></span></font></span></p><p align="left"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="COLOR: black;"><span style="COLOR: black;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体">&nbsp; （<span lang="EN-US">3）<span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;">省立医院的医生说分流速度快（<span lang="EN-US" style="COLOR: black;">CW测 Vmax: 413cm/s , PGmax: 68.2 mmHg）不易愈合，您经验丰富，认为自行愈合的几率有多大？</span></span></span></font></span></span></span></span></font></span></span></font></span></p><p align="left"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="COLOR: black;"><span style="COLOR: black;"><span style="FONT-SIZE: 16pt; COLOR: black; mso-bidi-font-size: 12.0pt;"><font face="宋体"><span lang="EN-US"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 宋体; mso-bidi-font-size: 12.0pt;"><span lang="EN-US" style="COLOR: black;">&nbsp; 谢谢！</span></span></span></font></span></span></span></span></font></span></span></font></span></p>

陆医生

您好：<br/>&nbsp;&nbsp;&nbsp; 缺损的变化是不可预测的，只有依靠科学检测手段来看。

pyxrdb

<p>谢谢专家答复。</p><p>我会按照您的建议定期进行复查。祝<font size="3"><span style="FONT-SIZE: 16pt; mso-bidi-font-size: 12.0pt;">您</span>工作顺利！</font></p>