体质量小于10kg的婴幼儿先天性心脏病的外科治疗

Surgical treatment of infants with CHD weighting less than 10 kg

目的 :分析我院施行心内直视手术的 2 96例体质量低于 1 0kg的婴幼儿先天性心脏病患者的临床资料 ,总结低体质量先心病患儿外科治疗的经验 .方法 :在 2 96例中 ,男 1 77例 ,女 1 1 9例 ,体质量 3～ 1 0kg ,平均 (7.5 2± 1 .82 )kg ,年龄 3d～32mo ,平均 (1 4 .2 3± 5 .6 5 )mo ,其中体质量≤ 5kg的 2 3例 (7.8% ) .心脏停跳心内直视手术 5 8例 (1 9.6 % ) ;心脏不停跳心内直视手术 2 38例 (80 .4 % ) ,后者主要用于简单心内畸形的矫治 .比较心脏停跳与不停跳组在体外循环 (CPB)期间及术后相关指标的改变 .结果 :全组死亡 1 7例 ,死亡率 5 .7% .其中体质量≤ 5kg患儿 4例 ,死亡率 1 7.4 % (4 / 2 3) ,体质量 >5kg患儿 1 3例 ,死亡率 4 .8% (1 3/ 2 73) ,两者之间相差显著 (P <0 .0 5 ) .不停跳心内直视手术死亡率为 2 .9% (7/ 2 38) .死亡原因 :1 0例复杂畸形的死亡患儿中 ,死于低心排 6例、心律紊乱3例和呼吸衰竭 1例 ;其他 7例患儿死于低心排 2例、心率紊乱 3例和呼吸衰竭 2例 .结论 :低体质量和畸形复杂是增加婴幼儿先天性心脏病手术风险的重要因素 .心脏不停跳心内直视手术可安全应用于简单婴幼儿先天性心脏病的外科治疗中 .

AIM: To analyze the clinical data of 296 infants with congenital heart disease (CHD), who weighed less than 10 kg in our department from 1998/05 to 2003/05. METHODS: Two hundred and ninty six children, of whom were 177 boys and 119 girls, with mean age (14.23±5.65) months (ranging from 1 day to 32 months) and mean weight of body (7.52±1.82) kg (ranging from 3 to 10 kg), were enrolled in the study. Twenty three infants (7.8%) weighed no more than 5 kg. Fifty eight (19.6%) infants with complicated CHD had surgical treatment of cardiopulmonary bypass (CPB) with arrested heart and 238 (80.4%) infants with simple CHD were surgically treated by CPB with beating heart. RESULTS: Of the 17 (5.7%) dead cases, 10 were diagnosed with complicated CHD. Death mainly resulted from low cardiac output, arrhythmia and respiratory failure. The mortalities of infants weighing no more than 5 kg and more than 5 kg were 17.4% (4/23) and 4.8% (13/273) ( P < 0.05), respectively. A low mortality (2.9%, 7/238) was found in infants who underwent operation on pump with beating heart. CONCLUSION: Complex anomalies and low body weight should be considered to be the main risk factors for surgical treatment in infants with CHD. Operations on pump with beating heart are a safer and more reliable option for infants with simple CHD.