73例新生儿先天性心脏病的手术时机选择分析

Surgical repair of congenital heart disease in neonates： strategy of treatment in 73 cases

目的探讨新生儿期先天性心脏病的内外科治疗结果及经验。方法2010年1月至2011年6月间73例在我院就诊的先天性心脏病新生儿，体重1．6～5kg，平均（3．1±0．7）kg。早产儿有14例。54例实施了手术治疗，其中45例在体外循环下手术，9例在非体外循环下实施手术。结果73例患儿中12例自动放弃治疗，7例经治疗后随诊择期手术治疗，54例手术患儿中近期死亡5例，病死率9％。结论开展新生儿期复杂性先天性心脏病的手术治疗应遵循早期诊断、专科治疗、及时手术的原则。对于无明显的心功能不全和反复肺部感染症状的患儿，可密切门诊随访；新生儿期就出现明显的心功能不全表现者必须及时手术。对于严重低氧血症或伴有循环梗阻的先天性心脏病及气道压迫明显的肺动脉吊带患儿应积极完善术前准备，早期手术，可明显降低病死率，改善治疗效果。

Objective To assess the outcome and experience of treatment in neonatal congenital heart disease. Methods From January 2010 to June 2011, 73 newborn with congenital heart disease were admitted to our department. The body weights ranged from 1.6-5.0 kg（Mean 3.1 ± 0. 7 kg）. There were 14 premature infants. 54 of them accepted surgical operation. 45 cases underwent operation with CPB,while 9 cases underwent without CPB. Results In 12 cases,parents did not consent to treatment. 7 cases got better after medical treatment and was discharged from hospital. 5 cases diedwithin 48 hours after surgery （mortality rate 9%）. Conclusions Treatmentof neonates with congenital heart disease should follow the principle of early diagnosis, specialty treatment, surgical intervention in time. Method of surgical treatment in different CHD patient depends on clinical manifestation and CHD types. Neonates without heart failure and pneumonia should be followed up inoutpatient. Patients with significant hypoxemia or circulation instability should be operated early.