新生儿危重先天性心脏病心内直视手术

Open heart operation on neonates with critical congenital heart disease

目的 总结连续 12例新生儿危重复杂先天性心脏病体外循环外科治疗结果和经验 ,探讨新生儿心脏手术围术期处理措施。 方法 2 0 0 1年 5月至 2 0 0 3年 1月 ,手术治疗 12例新生儿危重复杂先天性心脏病 (手术年龄 6～30天 ,体重 2 .8～ 4 .5 kg) ,包括完全型大动脉转位 4例 ,室间隔缺损合并房间隔缺损 5例 ,完全型房室隔缺损、梗阻性心上型完全性肺静脉异位引流、心脏多发性横纹肌瘤各 1例。 12例均在体外循环下行心脏大血管畸形解剖矫治。结果 术后呼吸机支持 10小时～ 9天 ,在 ICU监护 2～ 11天 ,术后 7～ 19天出院 ;术后并发症有低心排血量、纵隔感染、呼吸窘迫综合征、渗漏综合征和急性肾功能衰竭 ;12例患者全部治愈 ,随访 6个月～ 2年 ,生长发育正常。 结论 良好的体外循环管理和恰当的围术期处理是提高手术成功率的关键 ,积极使用腹膜透析治疗术后低心排血量、急性肾功能衰竭所致的少尿、水肿是有效和安全的。

Objective To summarize the experience of open heart operation on neonates with critical and complex congenital heart diseases and evaluate the methods of perioperative management. Methods From May 2001 to January 2003, 12 patients of neonates with congenital heart diseases underwent emergency operation. Their operating ages ranged from 6 to 30 days, the body weights were 2.8 to 4.5 kg. Their diagnoses included D-transposition of the great arteries in 4 cases, ventricular septal defect with atrial septal defect in 5 cases, complete atrioventricular septal defect, obstructed supracardiac total anomalous pulmonary venous drainage and cardiac rhabdomyomas in 1 case respectively. 12 cases were operated under moderate or deep hypothermic cardiopulmonary bypass. Results All cases were observed in ICU for 2-11 days and discharged 7-19 days after operation. The postoperative complications included low cardiac output, mediastinal infection, respiratory distress syndrome, systemic capillary leak syndrome and acute renal failure. All cases were cured and the follow-up (from 6 months to 2 years) showed satisfactory outcome. Conclusion A particular cardiopulmonary bypass and proper perioperative management is very important to ensure the successful outcome. Peritoneal dialysis is an effective and safe method for treating acute renal failure after cardiac operation in neonates.