新生儿危重先天性心脏病手术时机选择及术前调整策略

Timing and preoperative adjustment strategy for neonatal critical congenital heart disease

目的探讨新生儿危重先心病手术治疗时机的选择及术前调整策略。方法收集从阜外医院PICU入组2019年9月~2020年9月期间行小儿外科手术先心病新生儿53例,及未行手术治疗新生儿共60例。未手术的7例中,5例自动出院,2例患儿院内死亡,接受手术的新生儿中位日龄为14天,男性37例,女性16例。以14d分组对比两组术后临床指标,比较两组临床预后情况。结果行外科手术治疗的年龄14 d以内(含)新生儿27例,年龄14 d以上新生儿26例,对比两组新生儿术前体质量无明显差异(3.344±0.428 vs.3.631±0.622)kg,对比术前转入ICU调整例数,两组无明显差异(16 vs.11),对比术前出现危重状态例数,两组无明显差异(9 vs.5)。临床预后对比,年龄14 d以上组术后呼吸机使用时间明显少于年龄14 d以内组(318±330 vs.156±167)h(P<0.05);ICU住院时间方面,14 d以上组明显少于14 d以内组新生儿(20±17 vs.11±6)d(P<0.01);术后并发症对比:两组新生儿在术后死亡率、渗漏、二次插管、延迟关胸等方面均无明显差异。结论新生儿年龄是否大于14天与院内死亡率、渗漏发生率、二次插管发生率、延迟关胸等方面无明显相关,危重先心病术前危重状态出现概率与年龄无相关,尽早外科手术治疗新生儿危重先天性心脏病并不能改善临床预后,推迟危重状态出现时间的ICU系统调整策略尤为重要。

AIM To discuss the timing of surgical treatment of neonatal critical congenital heart disease and the preoperative adjustment strategy.MATHODS From September 2019 to September 2020,60 cases of neonatal surgery children were admitted to our hospital.Among them,53 cases received surgical treatment and among the remaining 7 cases,5 cases were discharged automatically and 2 cases died.The median age of the neonates undergoing surgery was 14 days.There were 37 male newborns and 16 female newborns and they were divided into two groups by within or over 14 days.The postoperative clinical indicators and the clinical prognosis of the two groups were compared.RESULTS From September 2019 to September 2020,a total of 53 neonates underwent surgical treatment,of whom 27 neonates were within 14 days of age and 26 neonates were over 14 years old,with no significant difference in preoperative weight between the two groups(3.344 kg±0.428 kg vs.3.631 kg±0.622 kg).There was no significant difference in the number of adjusted cases transferred to ICU before operation(16 vs.11)and in the number of critically ill cases before operation between the two groups(9 vs.5).The time of using ventilator after operation in the group over 14 days was significantly less than that in the group within 14 days(318 h±330 h vs.156 h±167 h).The length of stay in the ICU in the over 14 days group was significantly less than that in the within 14 days group(20 d±17 d vs.11 d±6 d).There were no significant differences in postoperative mortality,leakage,secondary intubation and delayed chest closure between the two groups.CONCLUSION The probability of preoperative critical condition in neonatal critical congenital heart disease is not related to age.Early surgical treatment of neonatal critical congenital heart disease cannot improve the clinical prognosis.The ICU system adjustment strategy to delay the emergence of critical condition is particularly important.