10Kg以下婴幼儿先天性心脏病的外科治疗

Surgical Treatment of Congenital Heart Diseases in Infants Under Body Weight 10 Kg

目的提高低体重婴幼儿先天性心脏病的外科治疗水平。方法回顾性分析62例体重低于10Kg婴幼儿先天性心脏病的治疗结果。本组48例室间隔缺损中,复合畸形32例,复杂畸形14例,全组合并中重度肺动脉高压(PH)43例,均在全麻CPB下纠正畸形。结果术后并发肺炎13例,肺不张和右胸腔积液各3例,低心输出量综合征和肺高压危象各6例,右心功能衰竭5例,严重心律失常1例,死亡4例,治愈58例(93.5%)。结论低体重儿常病情重,复合畸形多,术前术后易合并肺部并发症,应加强围术期综合治疗,对反复呼吸道感染、存在多水平左向右分流或巨大室间隔缺损、合并中重度肺动脉高压、复杂畸形及因疾病导致患儿生长发育明显落后者均应积极手术。

Objective To improve surgical treatment levels for congenital heart diseases in infants under 10 Kg. Methods The clinical data of 62 infants with CHD were reviewed. Their mean body weight was 7.8 Kg ,and mean month was 14.6. Of 48 cases with VSD, 32 cases were multi-malformation, 14 cases were complex malformation. Pulmonary hypertension showed in 43 cases. All the patients were recorved after surgical treatment under general anesthesia and cardiopulmonary bypass. Results After the operation ,pneumonia complication occurred in 13 cases, atelectasis and right pleural effusion were 3 cases respectively , low cardiac output syndrome(LOCS) and pulmonary hypertensive crisis(PHC) were in 6 cases respectively . Right heart function failure was in 5 cases , and severe anomalous heart rate was one .The cure rate was 93.5% with mortality of 6.4%. Conclusions For the infants with CHD under 10 Kg, they often show severe, or suffer from multiple malformation in the heart. Before and after operation, it is easy for them to suffer from. So it is very important to strengthen the perioperative treatment. If they often have infection in resperatory system; multiple level shunt from left to right in heart ; major ventricular septal defect(VSD) and complicated with middle to severe pulmonary hypertension , or other complex CHD must be interfered with surgery as early as possible, and the diseases leads to retardation of growth development of the children, they should be operated as active as possible.