低体重儿危重先天性心脏病的早期体外循环手术治疗  

Early cardiopulmonary bypass surgery in critical low birth weight and premature infants with congenital heart defect

作　　者：宓亚平[1] 贾兵[1] 李炘[1] 叶明[1] 陈张根[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032

出　　处：《中华急诊医学杂志》2008年第8期817-820,共4页Chinese Journal of Emergency Medicine

基　　金：上海市重点学科建设资助项目（B116）

摘　　要：目的回顾性分析评价低体重儿危重先天性心脏病体外循环完全性根治手术治疗的效果。方法2003年11月至2007年12月，28例低出生体重儿因严重心功能不全或低氧血症在复旦大学附属儿科医院心外科早期行体外循环完全根治手术。男16例，女12例；平均孕期为34周（30—41周），其中14例为早产儿；平均出生体重2010g（1370—2500g）。手术时日龄平均27．46d（1—61d），手术时体质量平均2391g（1500—2500g）。先天性心脏病诊断包括：室间隔缺损（VSD）10例，完全性大动脉转位（TGA）6例，完全性肺静脉异位引流（TAPVD）5例，室间隔完整的肺动脉闭锁（PA／IVS）2例。主动脉缩窄（CoA）2例，主动脉弓离断（IAA）1例，三房心1例，右肺动脉异常起源于主动脉1例。结果术后早期死亡2例（2／28，7．14％）。手术后机械通气6—165h，（113．9±168．9）h，CICU滞留1—56d，（14．4±12．5）d。平均随访16．87个月（2周至50月），1例晚期死亡，2例需再手术或介入治疗。随访12个月，不需再次手术率约为84．4％。结论合并先天性心脏病的低体重儿，若临床心脏症状危重，药物无法控制，早期行体外循环心内根治手术可有较满意的效果，围术期注意加强重要脏器功能保护。Objective To evaluate early and mid-term results in infants, weighing less than 2 500 g, who underwent early cardiac surgery on cardiopulmonary bypass （CPB）. Method Since November 2003 to December 2007, 28 consecutive infants of less than 2 500 g underwent early cardiac surgery on CPB in Children＇ s Hospital Affiliated to Fudan University. Sixteen infants were male, and 12 infants were female. The mean pregnancy period was 34 weeks （30 to 41 weeks）, and 14 patients were premature, and the mean birth weight was 2 010 g（ 1 370 - 2 500 g）. Mean age at operation was 27.46 d （range 1 - 61 d）, and mean weight was 2 391 g （range 1 500 2 500 g）. Deep hypothermia circulatory arrest was used in 9. Indications for surgery were： ventricular septal defect （10 infants）, transposition of great arteries （6 infants）, totally anomalous pulmonary venous return （5 infants）, pulmonary atresia with intact ventrieular septum （2 infants）, coaretation of aorta （1 infants）, inten＇upted aortic arch （ 1 infants）, cortriatriatum （ 1 infants）, abnormal original of right pulmonary artery （ 1 infants）. Results Two （7.14%） infants died after operation at early phase. Mean duration of mechanical ventilation and intensive care unit stay were 113.9 h and 14.4 d, respectively. During follow-up （mean 16.87 months）, one died. Two patients needed reintervention. About 84.4% infants didn＇t need reintervention at the end of 12-month followup. Conclusions If medicine is useless, infants woth low birth weight and congenital heart defect can obtain satisfactory outcome ＇after CPB. Perioperative protection for virtual organs should be payed attention to.

关 键 词：先天性心脏病 低出生体质量 体外循环 儿科手术 

分 类 号：R726.5[医药卫生—儿科]