75例低龄低体重先心病急诊、亚急诊心内直视手术疗效分析  

Emergency and sub-emergency operations for congenital heart disease in 75 infants with a low age and a low body weight

作　　者：刘宇航[1] 文平[1] 刘启龙[1] 朱全伟[1] 王宁[1] 卢绪宁[1] 刘大为[1] 崔琳[1] Liu Yuhang;Wen Ping;Liu Qilong;Zhu Quanwei;Wang Ning;Lu Xuning;Liu Dawei;Cui Lin(Department of Cardiothoracic Surgery,Municipal Children's Hospital,Dalian 116012,China)

机构地区：[1]大连市儿童医院心胸外科

出　　处：《临床小儿外科杂志》2019年第9期779-783,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨6月龄以内体质量5kg以下低体重婴幼儿先天性心脏病急诊、亚急诊心内直视手术的围手术期处理方法,并评估其干预效果。方法以2014年1月至2017年4月于大连市儿童医院接受急诊、亚急诊心内直视手术治疗的6月龄以内、体质量5kg以下的75例先天性心脏病患儿为研究对象。平均体重(4.2±0.8)kg,年龄6h至6个月。接受根治性手术者69例,接受姑息性手术者6例。对患儿的临床资料、各项检查结果及治疗情况进行分析。结果75例中住院死亡5例(6.67%),死亡原因:低心排综合综合征3例,重症感染1例,急性心包填塞1例。存活70例,均获随访,随访时间1~40个月。接受根治性手术后存活的64例中,室间隔缺损少量残余分流2例,主动脉弓血流速度加快2例,肺静脉吻合口血流速度加快1例,其余患儿均生长发育良好,心影缩小,肺动脉压正常;接受姑息手术的6例症状明显减轻,2例已顺利完成二期手术。结论随着围术期管理、麻醉以及体外循环技术的提高,对6月龄以内、体质量5kg以下低体重婴幼儿先天性心脏病实施急诊、亚急诊心内直视手术安全性较高,且疗效良好。Objective To explore the perioperative management of emergency and sub-emergency open heart operations for congenital heart disease (CHD) in infants aged under 6 months with a low body weight of 5 kg or less. Methods From January 2014 to April 2017,emergency and sub-emergency open heart operations were performed for 75 CHD infants aged under 6 months of age with a body weight of (4.2±0.8) kg.Radical ( n =69) and palliative ( n =6) operations were performed. Results Among them,5 (6.67%) died in hospital due to low cardiac syndrome ( n =3),severe infection ( n =1) and acute pericardial tamponade ( n =1).The remainders survived and were followed up for 1 to 40 months.Among 64 survivors of radical procedures,there were a small residual ventricular septal defect ( n =2),aortic arch flow velocity ( n =2) and accelerated blood flow velocity in pulmonary vein anastomosis ( n =1).Cardiac silhouette narrowed and pulmonary artery pressure was normal.Six cases of palliative surgery were significantly relieved and 2 cases completed the second stage of surgery. Conclusion With the improvements of perioperative management,anesthesia,cardiopulmonary bypass and surgical techniques,emergency and sub-emergency open heart operations are both safe and efficacious for CHD infants aged under 6 months with a low birth weight of 5 kg.

关 键 词：心脏病/先天性 低体重 婴儿 治疗结果 

分 类 号：R726[医药卫生—儿科] R654.2[医药卫生—临床医学]