延迟关胸技术在婴儿复杂危重先心病手术中的应用

Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant.

目的 探讨延迟关胸技术在婴儿复杂危重先天性心脏病（先心病）手术中的应用价值.方法 2008年5月至2009年6月南京医科大学附属南京儿童医院共19例婴儿复杂危重先天性心脏病患儿接受术后延迟关胸治疗,患儿年龄2 d至18个月,体重3～10 kg,延迟关胸时间1～4 d,平均（1.26±0.52）d.结果 19例中,痊愈14例,死亡2例,2例放弃治疗,1例远期死亡.结论 对于复杂危重先心病手术后出现低心排、血流动力学不稳定、出血、心律失常、心肌水肿等严重并发症的婴儿,延迟关胸是一种安全有效的解决方法.正确采取延迟关胸技术可以有效降低婴儿复杂危重先心病手术的死亡率.

Objective The purpose of this study was to determine the effects of delayed sternal closure （DSC） in operations for complex and severe congenital heart disease in infants. Methods Between May 2008 and June 2009, 19 infant cases with complex and severe congenital heart disease underwent delayed sternal clo- sure. The age ranged from 2 days to 18 months and the body weight ranged from 3 kg tol0 kg. The traction was removed successfully in the ICU between 1 and 4 days （ mean 1.26 ± 0.52 days）. Results In 19cases, 14 were recovery, 2 deaths, 2 giving up treatment and 1 death a few months late. Conclusion The technique of delayed sternal closure may help to overcome the problems such as low cardiac output syndrome, unstable he- modynamic conditions, hemorrhage, arhythmias, myocardium edema etc. DSC is a simple, safe and very useful technique for the complex cardiac diseases. DSC according to the indictors could decrease the mortality of the cardiac operations for the infant patients with complex and severe congenital heart disease effectively.