新生儿危重先天性心脏病的外科治疗

Surgical treatment of newborns with congenital heart diseases

目的 总结连续 8例新生儿危重先天性心脏病 (先心病 )的外科治疗结果和经验。方法 2 0 0 1年 5月至 2 0 0 2年 2月 ,手术治疗 8例危重先心病新生儿 ,手术年龄 6～ 30d ,体重 3～ 4 5kg ,包括室间隔完整的完全性大动脉错位 3例 ,室间隔缺损合并房间隔缺损 (ASD) 2例 ,完全性房室隔缺损 1例 ,心上型完全性肺静脉异位引流合并ASD 1例 ,动脉导管未闭 1例。对动脉导管未闭 (PDA)患儿在常温全麻下结扎 ,其余 7例均在中低温或深低温体外循环下行心脏大血管畸形解剖矫治。结果 8例均治愈 ,在监护室逗留 2～ 10d ,术后 7～ 15d出院。术后并发症有低心排、纵隔感染及呼吸窘迫综合征。出院后随访结果满意。结论 对新生儿危重复杂先心病应早期诊断 ,积极开展手术治疗。

Objective To summarize the experience of surgical treatment of newborns with congenital heart diseases. Methods The experience of surgical treatment of 8 newborns with critical congenital heart diseases, including 3 cases of D transposition of great arteries with intact ventricular septum, 2 cases of ventricular septal defect with artrial defect (ASD), one case of complete atrioventricular canal defect, 1 case of obstructed supracardiac total anomalous pulmonary venous drainage with ASD, and 1 case of patent ductus arteriosus (PDA). Results The case of PDA underwent ligation under normothermic anesthesia and the other 7 cases were operated upon under moderate or deep hypothermic cardiopulmonary bypass. All the 8 cases were observed in ICU for 2～10 days, and were discharged 7～15 days after operation. The follow up after discharge showed a satisfying outcome. The postoperative complications included low cardiac output, infection of mediastinum, and respiratory distress syndrome. Conclusion The critical and complex congenital heart diseases should by diagnosed as early as possible and emergency operation is effective and feasible.