婴幼儿先天性心脏病心内直视手术98例报告

Experience of open heart surgery in 98 infants with congenital heart disease

目的总结婴幼儿先天性心脏病(CHD)体外循环(CPB)下心内直视手术治疗经验;探讨提高手术疗效的技术和方法。方法CHD98例。年龄4~36个月,平均(20.2±4.2)个月。体重5.2~19 kg,平均(12.2±2.1)kg。室间隔缺损58例,房间隔缺损9例,法洛四联症12例,法洛三联症4例,重度肺动脉瓣狭窄4例,部分型房室通道5例,右室双出口2例,窗形动脉导管未闭2例,主-肺动脉窗1例,完全型房室通道1例。手术在CPB下进行,使用鼓泡式氧合器68例,膜式氧合器30例(其中28例加改良超滤)。所有病例均一期行相应各病种矫治术。CPB时间25~156 min,平均(56.4±12.1)min;主动脉阻断时间10~98 min,平均(35.4±10.2)min。术后呼吸机辅助时间3 h^7 d,平均(7.8±2.6)h。住院时间3~29 d,平均(12.8±3.6)d。结果术后30 d内死亡7例,住院病死率为7.1%。死亡病例均为体重10 kg以下患儿。76例获门诊随访,随访时间2~72个月,无远期死亡。结论婴幼儿CHD的手术疗效提高有赖于整体诊疗水平的进步。只要准确掌握手术适应证,正确围术期处理,改进CPB技术,就可明显提高手术疗效,其中使用膜式氧合器加超滤是关键之一。

Objective To summarize clinical effect and experience of open heart surgery under cardiopulmonary bypass （CPB） in infants with congenital heart disease （CHD） and to approach surgical ＇techniques and methods for improving the operation efficacy. Methods There were 98 infants under 36 months with CHD cases ,whose mean age was （20. 2±4.2） months and mean body weight was （12.2±2.1） kg, and among them 58 with ventricular septal defect, nine with atrial septat defect, twelvewith tetralogy of Fallot, four with trilogy of Fallot, four with severe pulmonary valve stenosis, five with partial common atrioventricular canal, two with double outlet right ventricle, two with window-shaped patent ductus arteriosus, one with AP window ,and one with complete common atrioventricular canal. All operations went under CPB ,using bubble oxygenator for 68 cases, membrane oxygenator for 30 cases and routine modified ultrafiltration for 28 cases. All patients primarily got corresponding correction of the disease. CPB time was from 25 min to 156 min with the mean （56. 4±12.1） rain. Aortic cross-clamping time was from 10 min to 98 min with the mean （35.4±10. 2） min. Postoperative mechanical ventilation time was from 3 h to 7 d with the mean （7.8±2. 6） h. Results Seven cases died after operations within 30 days, and the hospital mortality rate was 7.1%. The body weight of all the died infants were below 10 kg. Seventy-six cases got out-patient followup, and follow-up time was from 2 to 72 months. No late death occurred. Conclusion Infants CHD surgery effect depends on the progress of the overall diagnose and treat level. As long as we accurately grasp the surgical indications, do the correct perioperative management and improve CPB technology, we can significantly improve surgical treatment. And the use of ultrafiltration with membrane oxygenator is one of the key technologies.