低出生体重儿及早产儿先天性心脏病手术的麻醉处理

Anesthetic management of low birth weight neonates and premature infants undergoing cardiovascular operation

目的总结70例低出生体重新生儿及早产儿先天性心脏病手术的麻醉处理,并探讨其围术期的危险因素。方法 2003年6月至2011年4月共完成70例低出生体重新生儿及早产儿先天性心脏病手术。患儿孕周26～42(33.52±3.98)周,出生体重640～2500(1713.30±522.43)g。手术时日龄4～55(26.50±15.72)d,体重650～2712(1963.20±454.72)g。其中52例为早产儿。所有患儿均在全麻下完成先天性心脏病矫治术,其中非CPB手术34例,CPB下手术36例,其中心脏不停跳3例,深低温(<20℃)10例。结果术中死亡5例(7.14%),术后早期死亡(72h内)7例(10%),放弃治疗3例(4.29%)。CPB时间35～326(129.0±76.7)min;主动脉阻断时间27～173(77.8±47.3)min。术后机械通气时间12～648(116.9±128.1)h。16例延迟关胸,7例术后出血,心包填塞,需再次开胸止血。结论早产儿或低体重儿实施简单或复杂的先天性心脏病手术是安全和有效的;低体重儿可实施早期手术治疗;良好的麻醉管理有助于降低围术期的死亡率和并发症发生率,并提高术后的生存率。

Objective To summarize the anesthetic management of the low birth weight neonates with congenital heart disease. Methods Seventy cases undergoing surgical treatment from June 2003 to April 2012 were included in this study. The mean gestational age, age at operation, birth weight and weight at operation were 26-42（33.52±3.98） weeks, 4-55 （26.50±15.72）d, 640- 2 500（1 713.30±522.43）g, 650 2 712（1 963.20±454.72） g respectively. 52 cases were premature infants. All cases underwent cardiac operations under general anesthesia. 34 cases were operated without cardiopulmonary bypass （CPB）. 3 cases in 36 cases with CPB underwent beating heart technique surgery and 10 cases underwent deep hypothermia（-20℃）. Results The intraoperative and post-operative mortality was 5 cases （7.14%） and 12 cases （10%） respecitively, giving up treatment in 3 cases （4.29%）. The mean cardiopulmonary bypass time was 35-326 （129.0 ± 76.7） min and the mean aortic clamp time was 27-173 （77.8 ± 47.3）rain. The mean postoperative mechanical ventilation time was 12-648 （116.9 ± 128.1）h. The sternum left open in 16 cases. 7 cases faced bleeding needing surgical treatment postoperatively. Conclusion Given the challenging physiology in low birth weight neonates and.pretermature infants, optimal management includes early operation treatment and effective anesthetic management which could reduce perioperative mortality and improve postoperative survival rate.