新型冠状病毒感染后小儿先天性心脏病心脏手术的体外循环相关结果

Results of cardiopulmonary bypass related to cardiac surgery in children with congenital heart disease after novel coronavirus infection

目的回顾分析本院小儿心脏中心短时间内实施的大量新型冠状病毒感染后的先天性心脏病(先心病)患儿心脏手术的临床结果,总结体外循环相关临床结局和管理特点。方法2023年1月3日至2023年1月17日间,本院小儿心外科所有行心脏矫治术患儿共59例,回顾性分析该组患儿新冠感染相关流行病学资料、体外循环管理数据、手术前后心脏相关实验室检查和术后临床结果。结果复杂先心病13例(包括新生儿3例),简单先心病46例。其中3例新生儿始终新冠监测阴性,围术期感染新冠患儿中位转阴时间23.1 d,中位年龄10.5月,中位体重9.8 kg。转机时间为77(66,117)min,主动脉阻断时间49(29,66)min,术中使用肝素体重比5.1 mg/kg。呼吸机使用时间13.1(6.0,46.4)h,ICU时间46(18.7,112.6)h,术后住院天数6(6,9)d。患儿全部康复出院。结论针对新冠病毒感染后转阴的简单先心病患儿行体外循环下心内直视手术,按照常规方法进行治疗可以安全渡过围手术期,总体临床结果满意。

Objective This article aims to review and analyze the clinical results of a large number of children with congenital heart disease(CHD)after novel coronavirus infection in a short period of time in the pediatric heart center of our hospital,and summarize the clinical outcomes and management characteristics of cardiopulmonary bypass.Methods From January 3,2023 to January 17,2023,a total of 61 children in our pediatric cardiac surgery department who underwent cardiac correction surgery were retrospectively analyzed for the epidemiological data related to COVID-19 infection,the management data of extracorporeal circulation,the relevant laboratory examinations of the heart before and after surgery,and the clinical results after surgery.Result There were 13 cases of complex congenital heart disease(including 3 neonates)and 46 cases of simple congenital heart disease.Among them,3 neonates were always negative for COVID-19.The median time to negative transition of perioperative COVID-19 infected infants was 23.1d,median age was 10.5 months,and median body weight was 9.8 kg.The transfer time was 77(66,117)min,the aortic occlusion time was 49(29,66)min,and the heparin body weight ratio was 5.1 mg/kg.The ventilator use time was 13.1(6.0,46.4)h,the ICU time was 46(18.7,112.6)h,and the postoperative hospitalization time were 6(6,9)days.All the children recovered and were discharged from hospital.Conclusion Open heart surgery under cardiopulmonary bypass for children with simple congenital heart disease who turn negative after infection with the novel coronavirus can be treated in accordance with conventional methods and can safely survive the perioperative period,and the overall clinical results are satisfactory.