小于6个月婴儿先天性心脏病531例外科治疗

Surgical treatment of congenital heart disease of the 531 infants less than 6 months

目的 总结笔者所在医院小于6个月婴儿先天性心脏病手术治疗经验.方法 2005年1月—2014年12月,笔者所在医院共施行小于6个月婴儿先天性心脏病手术531例;其中男268例,女263例;年龄22 d至6个月,平均(4.0±2.2)个月;体重2.1~8.0 kg,平均(4.7±2.4)kg.病种包括室间隔缺损(VSD)352例、房间隔缺损(ASD)23例、肺动脉瓣狭窄(PS)4例、动脉导管未闭(PDA)20例、法洛四联症(TOF)18例、右心室双出口(DORV)5例、完全肺静脉异位引流(TAPVC)7例、完全性房室通道(CAVCD)5例、部分性房室通道(PAVCD)4例、肺动脉闭锁(PA)2例、VSD+ASD 48例、VSD+PDA 17例、VSD+ASD+PDA 6例、 二尖瓣关闭不全(MR)+VSD 7例、ASD+PS 5例、ASD+PDA 5例、主动脉缩窄(CoA)+VSD 3例.结果 手术死亡15例(2.83%).术后发生低心排血量综合征24例,肺部感染19例,右肺不张4例,右侧气胸1例,喉头水肿9例,细菌性心内膜炎1例,切口液化5例,Ⅲ度房室传导阻滞1例,二次开胸止血4例.术后6~12个月门诊随访462例(87.2%),发现VSD残余漏6例,右下肺不张2例,二尖瓣中度关闭不全2例,三尖瓣重度关闭不全1例.结论 开展小婴儿先天性心脏病手术,应结合自身的技术设备条件选择病种,把握好手术时机和手术指征,重视围手术期处理,可取得满意的临床效果.

Objective To summarize the experience of surgical therapy for congenital heart disease of infants less than 6 months.Methods From January 2005 to December 2014,the 531 infants less than 6 months with congenital heart disease underwent open heart surgery in author's hospital.There were 268 males and 263 females with their mean age of 4.0±2.2 months(range,22day-6months)and body weight of 4.7±2.4 kg(rang,2.1-8.0kg).Cardiac defects included 352 ventricular septal defect(VSD),23 atrial septal defect(ASD),4 pulmonary valve stenosis(PS),20 patent ductus arteriosus(PDA),18 tetralogy of failot(TOF),5 double outlet right ventricle(DORV),7 total anomalous pulmonary venous connection(TAPVC),5 complete atrioventricular canal(CAVC),4partly atrioventricular canal(PAVC),2 pulmonary atresia(PA),48 VSD and ASD,17 VSD and PDA,6 VSD+ASD+PDA,7 VSD and mitral regurgitation(MR),5 ASD +PS,5 ASD +PDA,3 VSD and coarctation of aorta(Co A).Results Among the 531 cases 15(2.83%)died postoperatively.Postoperative complications included low cardiac output syndrome in 24 patients,pneumonia in 19 patients,right atelectasis in 4 patients,right pneumothorax in 1patient,laryngeal edema in 9 patients,bacterial endocarditis in 1 patient,incision fat liquefaction in 5 patients,third-degree atrioventricular block in 1 patient,and reexploration for bleeding in 4 patients.A total of 462 patients were followed up for 6 to 12 months after discharge;6 patients of residual VSD shunt,2 patients of low right atelectasis,2 patients of moderate mitral regurgitation and 1 patient of severe tricuspid regurgitation was found.Conclusion In congenital heart disease surgery for infant,it should choose surgery according to the technology and equipment condition of the hospital,strictly grasp the surgical opportunity and indications,emphasis and improve the every respect of perioperation,so as to obtain satisfactory clinical effect.