先天性心脏病外科进展

Advance in surgery of congenital heart disease

先天性心脏病的发生率在新生儿中高达6.7‰,每年我国约有15～20万名先天性心脏病出现。随着心脏外科的发展,该病外科可治性高、疗效好。如果对这些患儿不加处理,其中1/3患者因病情危重将在6个月～1岁内夭折。因此,未成熟儿、新生儿、婴幼儿期危重先天性心脏病外科治疗仍成为21世纪心脏外科的挑战。除了外科操作技术的发展外,各学科密切配合是心脏外科迅速发展的重要前提。心内科对该病的病理解剖和血流动力学资料的结合已成为诊断统一体;心内外科镶嵌治疗成为婴幼儿心脏外科手术成功的重要保证;体外循环设备技术的发展,使新生儿、婴幼儿患者对体外循环耐受性提高,保证外科医师有足够时间进行精细手术操作;麻醉、监护设备和技术的创新,提高了患者对手术应激的耐受性,降低了不必要的机体能量消耗,加快了康复,提高手术的生存率;ECMO或VAD已成为复杂先天性心脏病围术期心肺支持的重要手段;合成和生物材料的更新,提高了复杂先天性心脏病的可治率,延长了植入材料的寿命;未成熟心肌、肺、脑、肾等重要脏器的保护和胎儿心脏外科是当今先天性心脏病外科发展的热点。

The incidence of congenital heart disease in neonate is up to 6. 7‰. Every year, 150 000 to 200 000 cases of congenital heart disease appear in our country. Along with the development of cardiac surgery , these patients can accept reliable treatment with good result. Otherwise, one-third of them will die between six to twelve months after birth due to critical condition without any intervention. So cardiac surgery treatment toward critical congenital heart disease in premature neonates, neonates and infants remains a challenge in 21th century. Besides the progress in surgical manipulation technique, close cooperation between associated subjects becomes an important premise for the rapid advancement in cardiac surgery. In cardiology, the combination of pathological anatomy and hemodynamic data make the diagnosis an entity. Mosaic treatment with cardiology and surgery ensures success of cardiac surgery in infants. Improvement of equipment in extracorporeal bypass enhances the toleration for operation in neonates and infants, thus guarantee surgeons for plenty time of careful manipulation. Innovation of anesthesia and intensive care equipment enhance the toleration to surgery stress, decrease the unnecessary energy consumption, improve the rehabilitation and operation success. Now, extracorporal membrane oxygenator ( ECMO) and ventricular assist device ( VAD) has became an important method in peri-operation treatment of complicated congenital heart disease. Renewal of prosthetic and biological material improves the curative possibility of congenital heart disease and duration of the implanted material. Premature myocadiac, pulmonary, cerebral protection and fetal cardiac operation are the focus of congenital heart disease surgery at the present time.