新生儿危重先天性心脏病的术前术后一体化救治经验

Integrated perioperative treatment of neonatal critical congenital heart disease

目的总结新生儿危重先天性心脏病(Critical congenital heart disease,cCHD)术前术后一体化救治经验。方法收集2019年3月至2021年3月云南省阜外心血管病医院收治的39例新生儿cCHD临床资料,男24例,女15例。其中早产儿4例,双胎3例;顺产25例,剖宫产14例。出生体重1.5~4.2(2.97±0.59)kg,入院日龄0~28(14.0±8.8)天,入院身高40~57(49.0±4.1)cm,入院体重1.6~4.8(3.0±0.7)kg。39例中30例行手术治疗,其中体外循环下心脏直视手术22例,非体外循环手术8例;矫治手术28例,姑息手术2例;延迟关胸2例。结果术后呼吸机治疗时间19~2778[48.0(156.5,383.0)]h[因结果呈偏态分布,采用M(P25,P75)表示,下同],ICU停留时间2~152[19.3(23.0,31.7)]d,总住院时间8~159[27.3(33.0,48.5)]d。全组无手术死亡;1例并发坏死性小肠结肠炎,家属拒绝行开腹探查术而放弃治疗,自动出院。随访2~24月,1例于出院1周后因呛奶窒息死亡;另1例因心功能差,术后6个月死亡;其余患儿均恢复良好。结论cCHD新生儿应迅速转移到设备齐全、技术力量强的小儿心脏中心进行救治。术前维持内环境稳定、平衡体-肺循环阻力等综合治疗,对导管依赖型cCHD应用前列腺素E1泵入,可改善患儿的状态,创造良好的手术机会。及时的手术或介入治疗是救治cCHD患儿的关键,精细的围术期管理是救治成功的重要保障。

Objective To summarize the experience of integrated perioperative treatment of neonatal critical congenital heart disease(cCHD).Methods A total of 39 newborns with cCHD admitted to Fuwai Cardiovascular Hospital in Yunnan Province from March 2019 to March 2021 were collected,including 24 males and 15 females.Among them,four were premature babies,and three were twin;25 cases were normal delivery and14 cases were cesarean section.The birth weight ranged from 1.5 to 4.2 kg[(2.97±0.59)kg]with age from 0 to 28 days[(14.0±8.8)days],height from 40 to 57 cm[(49.0±4.1)cm],and admission weight from 1.6 to 4.8 kg[(3.0±0.7)kg].Thirty patients underwent surgical treatment,including 22 cases of open heart surgery under cardiopulmonary bypass and 8 of non-pulmonary bypass surgery of which 28 underwent corrective surgery and 2 palliative surgery with 2 delayed chest closure.Results Postoperative ventilator time was 19~2778 hours,skewed distribution data were described as M(P25,P75),the same as below.ICU retention time was 2~152[19.3(23.0,31.7)]days and total hospital stay was 8~159[27.3(33.0,48.5)]days.There was no operative death in the whole group.One case was complicated by necrotizing enterocolitis and the family refused to perform laparotomy and gave up continue treatment.During a follow-up of 2~24 months,one case died of choking and asphyxiation one week after discharged and another died of heart failure 6 months after discharged;the rest of the children recovered well.Conclusion Newborn with cCHD should be immediately transferred to a well-equipped and strong technical pediatric heart center.Initial therapy includes keeping inner environment stable,balancing systemic and pulmonary blood flow and pumping prostaglandin E1 for duct-dependent c CHD.Preoperative adequate treatments can avoid from life-threatening condition and supply a better state for surgery.Timely surgery or catheter-based intervention is the key to the treatment of newborns with cCHD.