急诊外科治疗危重婴儿先天性心脏病的临床疗效分析

Emergency surgical treatment on critical infants with congenital heart diseases

目的回顾性分析258例小于1岁的危重婴儿先天性心脏病的急诊外科治疗的临床疗效。方法从2006年1月至2009年2月期间,我院心血管外科住院患儿中,诊断明确后24h内接受外科手术治疗的258例危重先天性心脏病患儿,男性150例(58.1%),女性108(41.9%);年龄6d至11个月[(7.5±4.3)个月];体质量2.1～9.5(5.5±3.3)kg。术前合并有急性心功能衰竭、呼吸功能衰竭、肺部感染、重度贫血、营养不良、肝肾功能不全等严重并发症患儿占90.2%(233例)。全组中246例(95.3%)在体外循环下行心脏畸形矫治,12例(4.7%)行动脉导管结扎术。结果全组心血管畸形一期矫治率为92.3%,总治愈率达到96.9%。患儿的心内直视手术是在心脏停跳与心脏不停跳两种方法下进行,两者体外循环时间分别约(105.00±38.71)、(71.89±27.78)min。术后呼吸机支持时间为6～154(16.5±9.3)h;ICU住院时间为48～174(98.5±33.6)h;术后低心排综合征发生率为6.9%;心肺脑肝肾重要脏器严重并发症发生率为12.9%;死亡8例(3.1%),死亡原因:7例复杂畸形患儿中死于低心排综合征5例,心律紊乱1例,呼吸衰竭1例;另1例患儿死于心率紊乱。结论危重婴儿先心病在明确诊断后尽快进行外科手术治疗,并发有心肺肝肾等重要脏器功能不全者并不是手术绝对禁忌证;低月龄和畸形复杂是婴儿先天性心脏病手术治疗风险增加的重要因素。

Objective To evaluate the efficiency of emergency surgery to consecutive 258 infants suffering with critical congenital heart diseases （CHD）. Methods From January 2006 and February 2009, emergency surgery was performed within 24 h after definite diagnosis on 258 children with critical congenital heart diseases, including 150 males （58.1%） and 108 females （41.9%）, with a mean age of （7.5 _＋4.3） months （ranging from 6 d to 11 months）, at a mean weight of （5.5±3.3） kg （ranging from 2.1 to 9.5 kg）. Complications such as refractory pneumonia, heart failure, repeated episodes of hypoxic spells, kidney dysfunction, liver dysfunction, severe anaemia or growth retardation were found in 233 infants （90.2%）. Totally 246 （95.3%） of them were operated on CPB with heart arrested, and 12 （4.7%） with patent ductus arteriosus and operated off pump. Results This group of patients had a stage-one corrective rate of 92.3%, and a total curative rate of 96. 9%. In infants operated with heart arrested and with heart beating, the duration of cardiopulmonary bypass was 105.00 ±38.71 rain and （71.89 ± 27.78 ） rain respectively, postoperative ventilation duration was （ 16.5 ± 9. 3 ） h, intensive care unit （ICU） staying duration was （98.5 ± 33.6） h. After operation, low cardiac output syndrome occourred with a rate of 6.9% and severe complications of major organs with a rate of 12.9%. Of 8 （3. 1% ） dead infants, 7 were diagnosed with complicated CHD. Five died of low cardiac output syndrome, 1 of arrhythmia, 1 of respiratory failure and 1 of arrhythmic heart. Conclusion Emergency surgical treatment should be performed as soon as definite diagnosis for critical infants with congenital heart disease. Heart failure, respiratory failure, liver dysfunction, severe anaemia and infection are not contraindications to surgical treatment. However, complex anomalies and younger age are considered to be the most risk factors for surgery of infants with CHD.