小婴儿危重先天性心脏病的急症手术

Emergency Operation on Critical Congenital Heart Disease in Infants

目的：评估小婴儿危重先天性心脏病（先心病）急症手术的可行性。方法：≤６个月危重先心病患儿１８例，内科治疗无效，准备１～２天，在体外循环下急症手术。病种为室间隔缺损伴肺动脉高压、法洛四联症、肺动脉闭锁、大动脉错位和单心室等。姑息手术３例，根治术１５例。结果：手术病死率５．６％（１／１８）。术后生存者在监护室中逗留平均１３．４天，术后平均１６．４天出院。术后并发症有气胸、胸腔渗血多、消化道出血和条件性致病感染等，均治愈。结论：树立小婴儿危重先心病急症手术的意识，充分利用非创伤性诊断技术，术前在最短时间内使患儿病情达“最佳状态”，改进体外循环和心肌保护技术，将麻醉持续至术后监护阶段，预防和治疗条件性致病菌感染，及时发现和处理残余畸形及并发症。

Objective: To evaluate the feasibility of the emergency operation on critical congenital heart disease(CHD) in infants. Methods: Unselected operations under extracorporeal circulation (ECC) were performed on 18 cases of CHD. Their age was under 6 months. The diagnosis included ventricular septal defect with pulmonary hypertension, tetralogy of Fallot, pulmonary atresia, transposition of the great artery, and single ventricle. Corrective operations were performed on 15 patients and palliative operations on 3. Results: Overall hospital mortality was 5.6 %(1/18). Intensive care unit (ICU) stay and postoperative hospital stay were 13.4 days and 16.4 days respectively. Postoperative complications included pneumothorax, hemothorax, stress bleeding of digestive tract, and coincidental infections. All of those complications were cured by proper treatment. Conclusions: Emergency operation when necessary is effective and feasible on the basis of 'emergent conception', noninvasive diagnosis, optimal preparation in time, improved ECC and maintaining anesthesia in ICU, Awareness of complications and prompt treatment should be stressed.