218例6个月以下先心病患儿的外科治疗  

Surgical treatment of congenital heart disease in children under 6 months old: Analysis of 218 cases

作　　者：沈立[1] 顾海涛[1] 莫绪明[1] 钱龙宝[1] 夏建海[1] 王振喜[1] 景华[2] 

机构地区：[1]南京医科大学附属南京儿童医院心胸外科,南京210008 [2]南京大学医学院临床学院(南京军区南京总医院)心胸外科,南京210002

出　　处：《医学研究生学报》2010年第12期1261-1264,共4页Journal of Medical Postgraduates

基　　金：南京市医学科技发展项目(YKK07052)

摘　　要：目的随着心脏外科学的发展,先心病的治疗越趋于低龄化和复杂化。文中回顾分析6个月以下先心病患儿的外科治疗结果 ,结合文献探讨6个月以下先心病患儿的综合治疗策略。方法自2007年1月至2008年6月共收治6个月以下先心病患儿218例,所有患儿术前诊断明确,简单型先心病患儿158例（72.5%）,均行一期根治术;复杂型先心病60例（27.5%）,其中5例法乐四联症合并肺动脉闭锁行姑息性分流术,4例完全性大血管错位行分期矫治术,其余均行一期根治术,分期手术均严格随访,在术后0.5~1年接受二期手术。结果 218例均在体外循环下手术,体外循环时间为（20~158）min,平均（55.4±24.7）min;主动脉阻断时间0~128 min,平均（33.6±19.3）min;死亡7例,占3.3%,其余入ICU,首次呼吸机使用时间为2~114 h,平均（20.3±14.7）h;监护室逗留时间为1~20 d,平均（2.7±1.5）d。术后延迟关胸5例,占2.3%,难治性肺炎17例,占7.8%;再次呼吸机使用24例,占11.0%;消化道大出血1例,自发性肝破裂1例,气管软化5例,膈肌麻痹伴膈膨升1例。随访1~2.5年,患儿生长发育良好,无出院后死亡。室间隔缺损残余瘘14例,占6.4%,右心室流出道残余梗阻15例,占6.9%,均未再手术。结论先心病矫治水平的提高有赖于诊断技术、体外循环技术、手术技巧和术后监护技术的共同提高,先心病在婴儿期得到纠治可获得满意结果 。Objective With the development of cardiosurgery,surgical management of congenital heart disease（CHD） is becoming more and more complicated and involving more and more younger patients.This article was to explore comprehensive strategies for the treatment of CHD in children less than 6 months old.Methods From January 2007 to June 2008,218 CHD children younger than 6 months old received surgical treatment under the cardiopulmonary bypass（CPB）.Of the total number of cases,158（72.5%） were simple CHD and underwent radical repair,while the other 60（27.5%） were complex CHD and were,too,treated by radical repair,except 5 cases of pulmonary atresia with intact ventricular septum（PA/IVS） and 4 cases of D-transposition of the great arteries（d-TGA） that received staged palliation.Those treated by staged palliation were followed up for 0.5-1 year and then underwent a second-stage procedure.Results The CPB duration ranged from 20 to 158 minutes（55.4±24.7 min）,and the aortic clamping time from 0 to128 minutes（33.6±19.3 min）.Operative mortality was 3.3%（7/218）.Postoperative ventilation lasted 2-114 hours（20.3±14.7 h）,and ICU stay 1-20 days（2.7±1.5d）.Sternum closure was delayed in 5（2.3%） of the cases.Postoperative complications developed as follows： refractory pneumonia in 17 cases（7.8%）,re-ventilation in 24（11.0%）,massive hemorrhage of the digestive tract in 1（0.5%）,spontaneous liver rupture in 1（0.5%）,tracheomalacia in 5（2.3%） and diaphragm paralysis in 1（0.5%）.During the 1-2.5 years follow-up,all the patients were well developed and no post-discharge death occurred.There were 14 cases of VSD residual fistula（6.4%） and 15 cases of right ventricle outlet tract residual obstruction（6.9%）,but none necessitated second surgery.Conclusion The progress of CHD treatment depends on the co-development of the diagnosis,CPB,surgical techniques and ICU monitoring.CHD can be treated with satisfactory results during the infancy or neonatal period.

关 键 词：先天性心脏病 新生儿 手术治疗 

分 类 号：R654.2[医药卫生—外科学]