新生儿、小婴儿危重先心病的急诊手术治疗(附120例分析)

Emergency Operation on Critical Congenital Heart Disease in Neonates And Infants A Report of 120 Cases

目的总结新生儿、小婴儿危重先天性心脏病(先心病)急诊手术治疗的效果和经验,探讨低体重急诊先心病手术患儿的围术期处理。方法回顾性分析自2001年1月至2005年3月我院收治的120例危重先心病患儿急诊手术治疗的情况。结果术后呼吸机支持时间为14h～18d(4.7d±3.8d),监护室滞留时间为2d～22(d8.4d±7.5d)。全组死亡率为9.2%(11/120),其中术中死亡4例,监护室死亡3例,术后随访6～50月,远期死亡4例,再手术17例。结论急诊手术是挽救新生儿、小婴儿危重先心病的有效手段,手术成功的关键在于掌握手术适应症、正确选择手术方式以及体外循环技术和术后监护水平的提高。

Objective To summarize the clinical outcomes and experience of emergency operation on critical congenital heart disease （CHD） in neonates and infants, to explore perioperative management for these patients. Methods From Jan. 2000 to Mar. 2005, 28 neonates and 92 infants （male 81, female 39） with critical CHD who underwent emergency operation were reviewed. Age ranged from 2 days to 8 months （mean, 3.56±2.13 months）. Boby weight ranged from 1.25kg to 8kg （mean, 4.52±1.93kg）. The emergency operation included eradical procedure （n=94）, palliative （n=23） and first-stage repair （n=3）. Results The lasting time of intubation was 14h～18d （mean, 4.7±3.8d）, and intensive care unit （ICU） staying time was 2d～22d （mean, 8.4±7.5d）, The total mortality was 9.2% （11/120）. 4 patients died from the operation table and 3 patients died in ICU. Following up 6～50 months with 4 cases late death and 17 cases re-operation. Conclusions Emergency operation is effective means. The good prognosis can be obtained from accurate choice of indications and eradical operation.Improved cardiopulmonary bypass （CPB） technique and proper postoperative management should also be stressed.