新生儿重症先天性心脏病患儿的术前处理  

Pre-operative treatment in neonate with critical congenital heart diseases

作　　者：李志浩[1] 徐卓明[1] 周燕萍[1] 张海波[1] 郑景灏 鲁亚南[1] 

机构地区：[1]上海交通大学附属医学院上海儿童医学中心心胸外科,200127

出　　处：《中国小儿急救医学》2016年第4期252-255,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的分析新生儿重症先天性心脏病的流行病学及临床特征，探讨其术前治疗的要点。方法回顾性分析2014年6月至2015年6月我院心外科重症监护室收治的新生儿重症先天性心脏病病例，总结其病种分布和主要临床表现，术前治疗的要点，插管和手术的指征及其转归。结果期间共收治96例新生儿期重症先天性心脏病患儿，大动脉转位为主要病种（包括室间隔完整和伴有室间隔缺损），占全部病例的49％，严重紫绀为就诊时的主要症状，占全部病例的62．5％，其次为心力衰竭，占全部病例的33．3％。87例患儿于术前插管，其中入院后即刻予插管的41例，入院后24h内插管的40例。1例主动脉弓中断患儿术前死亡。所有患儿均于住院期间接受手术。结论大动脉转位是新生儿重症先天性心脏病的主要病种，紫绀是新生儿期重症先天性心脏病患儿的主要症状，术前治疗取决于不同先天性心脏病的解剖和血流动力学特点，严密监测内环境和代谢指标决定插管和适时的手术时机。Objective To analyze the epidemiology and clinical features of the critical congenital heart diseases in neonates, and to summarize the main points on pre-operative treatments. Methods We retrospectively analyzed all critical congenital heart disease in newborns admitted to CICU from June 2014 to June 2015. Depict entity distribution, the main symptoms, and the key points on their treatments ,also the indi- cation of intubation and their operation time were summarized. Results In totally 96 cases, transposition of the great artery ,with and without the intact ventricle septum, was the biggest category and counts for 49% in our group. Severe cyanosis was the main symptom for 62. 5 % of all cases. Another key symptom was the heart failure （33.3%）. Eight-seven cases were intubated during their treatments, in which 41 were intubated as soon as they were admitted and 40 cases were done in the first 24 hours after their admission. One case died before treatment due to interrupted aortic arch. All the rest received operations during their hospital stay. Conclusion Transposition of great artery is the dominating entity in critical congenital heart diseases in new- borns;severe cyanosis is the main symptom. Treatment should be based on each characteristic anatomy and hemodynamics features. Rigorous and dynamic monitoring on the homeostasis and metabolic index determines the indication of intubation and surgery time.

关 键 词：新生儿 重症先天性心脏病 紫绀 低氧血症. 

分 类 号：R722.1[医药卫生—儿科]