低体重婴幼儿危重先心病合并肺部感染的外科治疗  

Surgical treatment for severe acute congenital heart disease in low body weight infants with pulmonary infection

作　　者：吕瑛[1] 李小兵[1] 黄建成[1] 李志杰[1] 张会军[1] 王军[1] LYU Ying;LI Xiao-bing;HUANG Jian-Cheng;LI Zhi-jie;ZHANG Hui-jun;WANG Jun(Department of Cardiac Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 050031, China)

机构地区：[1]河北医科大学第一医院心外科,河北石家庄050031

出　　处：《河北医科大学学报》2020年第12期1406-1411,共6页Journal of Hebei Medical University

基　　金：河北省科学研究重点课题(20170522);河北省医学适用技术跟踪项目(GL2019036)。

摘　　要：目的评估低体重(≤5 kg)婴幼儿危重先心病合并肺部感染的外科手术效果,总结临床经验。方法收集心外科低体重(≤5 kg)危重先心病110例,所有患儿根据术前肺部情况分为感染组与非感染组,其中感染组64例,非感染组46例。研究低体重危重先心病合并肺部感染外科手术矫治的早期结果,分析感染组与非感染组围手术期并发症情况。结果2组患儿术中主动脉阻断时间和体外循环时间、二次插管组间差异无统计学意义,但机械通气时间(≥48 h)例数、机械通气时间(≥48 h),正性肌力药物时间、ICU时间(≥72 h),感染组高于非感染组,差异有统计学意义(P<0.05)。术后2组病原菌感染情况差异无统计学意义(P>0.05)。2组术后白细胞、C反应蛋白及降钙素原均先升高后降低至正常水平。2组在组间、时点间、组间·时间点交互作用差异均有统计学意义(P<0.05)。结论婴幼儿危重先心病术前合并肺部感染病情危重,围手术期并发症较非感染组高,但早期手术效果良好,治疗的关键在于加强心肌和肺脏保护,提高手术操作技术,缩短手术时间,加强抗感染,术后加强监护,及时处理各种术后并发症。Objective To evaluate the surgical effect of severe congenital heart disease with pulmonary infection in infants with low body weight(≤5 kg)and summarize the clinical experience.Methods A total of 110 cases of severe congenital heart disease with low body weight(≤5 kg)in cardiac surgery department were collected.According to the preoperative lung conditions,all the cases were divided into the infected group and the non-infected group,including 64 cases in the infected group and 46 cases in the non-infected group.To study the early results of surgical correction of low weight critical congenital heart disease complicated with pulmonary infection.The perioperative complications of the infected group and the non-infected group were analyzed.Results There was no statistically significant difference with the two groups in intraoperative aortic block time,extracorporeal circulation time,and the secondary intubation group,but the number of cases,duration of mechanical ventilation(≥48 h),duration of positive inotropic drug time and duration of ICU(≥72 h)in the infected group was higher than that in the non-infected group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of pathogen infection between two groups(P>0.05).After operation,white blood cells,C-reactive protein and procalcitonin in 2 groups were all increased first and then decreased to normal levels.There were statistically significant differences in the interaction between groups,time points,and time points between groups(P<0.05).Conclusion The critical congenital heart disease in infants was complicated with pulmonary infection before operation,and the perioperative complications were higher than those in the non-infected group,but the early operation effect was good.The key to the treatment is to strengthen the protection of myocardium and lungs,improve the operation technique,shorten the operation time,strengthen anti-infection and postoperative monitoring,and deal with all kinds of

关 键 词：心脏病 感染控制 婴儿 

分 类 号：R541.1[医药卫生—心血管疾病]