新生儿和小婴儿复杂先天性心脏病手术的发展和优化

The Surgical Development and Optimized Strategies of Neonates and Young Infants With Complicated Congenital Heart Diseases

目的:回顾新生儿(年龄≤28天)和小婴儿(28天<年龄≤90天)复杂先天性心脏病(先心病)外科治疗在上海新华医院、上海儿童医学中心的发展,对常见复杂先心病的手术方法、手术适应证和时机及围术期生命器官保护提出优化方案。方法:109例新生儿和193例小婴儿患复杂先心病而接受手术治疗。根据不同的年龄水平和手术阶段将资料按等级分组对照,A组:10例,为新生儿手术第一阶段;B组:19例,为新生儿手术第二阶段;C组:80例,为新生儿手术第三阶段;D组:10例,为小婴儿手术第一阶段;E组:31例,为小婴儿手术第二阶段;F组:152例,为小婴儿手术第三阶段。新生儿和小婴儿病种分布中大动脉转位最多,分别占66例(60.6%,66/109)和67例(34.7%,67/193)。结果:总住院死亡60例(19.9%,60/302),新生儿24例,小婴儿36例。A组、B组和C组的死亡率分别为40.0%(4/10)、57.9%(11/19)和11.2%(9/80)。D组、E组和F组的死亡率分别为70.0%(7/10)、29.0%(9/31)和13.2%(20/152)。F组患儿中大动脉转位和室间隔完整的肺动脉闭锁手术死亡率均明显高于C组。结论:对于复杂和危重先心病应该积极采取早期手术措施,并要求有急诊手术的观念。通过优化手术方法和强化围术期生命器官的保护以提高手术生存率。

Objective：The development of surgical managements of neonates （age≤28 days） and young infants （28 days 〈 age ≤ 90 days） with complicated congenital heart diseases was reviewed in Shanghai Xin Hua Hospital and Shanghai Children＇s Medical Center. The optimized surgical managements of complicated congenital heart disease, indications, time of operations and the protections of vital organs perioperations were discussed. Methods：From June 1973 to December,2004,109 neonates and 193 young infants with complicated congenital heart disease were received surgical therapies. The patients were divided into six groups according to their ages and time of operations. Group A： neonates operated from 1975-1990 （n = 10） ,group B： neonates operated from 1991-1999 （n = 19）, group C： neonates operated from 2000-2004 （n =80） ,group D. young infants operated from 1975-1990 （n = 10） ,group E： infants operated from1991-1999 （n = 31 ） ,and group F： infants operated from 2000-2004 （n = 152 ）. The dominant cases were D-TGA in the neonates （60. 6%, 66/109 ） and young infants＇ （34. 7 %, 67/193 ） groups, respectively. Result：There were 60 death cases（19. 9% ,60/302）,24 in the neonates groups,and 36 in the infants＇ groups. The death rates in the group A,B and C were 40. 0% （4/10） ,57.9% （11/19） 和 11.2% （9/80） ,respectively. The death rates in the group D,E and F were 70. 0% （7/10） ,29. 0% （9/31）和 13.2% （20/152） ,respectively. The death rates of D-TGA and PA/IVS in the group F were much higher than those in the group C. Conclusion： It is very important to take the earlier operations or the emergency operations to those neonates and young infants with complicated and critical congenital heart diseases. The optimized surgical managements and reinforcements of protections of vital organs perioperations can decrease the operative mortality.