新生儿和小婴儿危重先天性心脏病急诊手术

Emergency operation on neonates and infants with critical congenital heart defects

目的探讨新生儿和小婴儿危重先天性心脏病急诊手术的必要性及提高手术疗效的措施。方法收集新生儿和小婴儿危重先天性心脏病55例的急诊手术资料,男性35例,女性20例。患儿术前有反复肺炎心衰史或持续缺氧发作,其中动脉导管未闭(PDA)合并肺动脉高压(PH)3例、室间隔缺损(VSD)伴肺动脉高压34例、室间隔缺损(VSD)合并房间隔缺损(ASD)8例、室间隔缺损合并动脉导管未闭4例、严重肺动脉狭窄(PS)合并房间隔缺损4例、法洛四联症(TOF)2例,均行急诊手术治疗。结果术后并发气胸3例、呼吸机相关性肺炎2例、拔管后再插管3例、低心排2例、术后早期严重心功能不全合并有毛细血管渗漏综合征3例,常规治疗下仍少尿或无尿,持续3～5h,肺内渗出增多,中心静脉压进行性上升,均行腹膜透析治疗。全组病例51例痊愈出院,死亡4例。结论新生儿和小婴儿危重先天性心脏病急诊手术效果较好。合理的围手术期管理、合适的体外循环方法及手术方案是提高手术成功率的关键。

Objective To explore the importance of emergency operation and methods for critical congenital heart defects in neonates and infants. Methods The data of emergency operation of 55 cases （35 males and 20 females ） with critical congenital heart defects were collected. The conditions before operation showed with recurrent respiratory infection, congestine heart failure or continuous episodes of bypoxemia in all patients.The diagnosis included patent ductus arteriosus （PDA） with pulmonary hypertension （PH） 3 cases. Interventricular septal defect （VSD） with PH 34 cases, VSD with Interatrial septal defect （ASD） 8 cases,VSD with PDA 4 cases, pulmonary stenosis （PS） with ASD 4 cases, and tetralogy of Fallot （TOF） 2 cases.Results Postoperative complications included pneumothorax （3 case）, ventilator-associatod pneumonia （2 cases ）, re-ventilation （3 case ） and low output syndrome （2 cases）.3 cases who suffered from critical heart failure with capillary leakage syndrome needed dialysis. 51 patients were going well, 4 patients were dead. Conclusion Emergency operation is effective for critical congenital heart defects in neonates and infants.Proper perioperative and cardiopulmonary bypass （CPB） management and rational operations are important to ensure the operation success.