摘要
目的回顾和总结新生儿和小婴儿心脏病手术在上海新华医院、上海儿童医学中心的发展和目前状况，并对新生儿和小婴儿心脏病手术的适应证、手术时机选择、强化围术期生命器官的保护提出方案。方法1973年6月-2004年5月115例新生儿和281例小婴儿在上海第二医科大学新华医院、上海儿童医学中心接受先天性心脏病外科治疗。根据不同的年龄和手术阶段将资料按等级分组对照，N／Ⅰ组：15例，为新生儿第1阶段；N／Ⅱ组：21例，为新生儿第2阶段；N／Ⅲ组：79例，为新生儿第3阶段；I／Ⅰ组：26例，为小婴儿第1阶段；I／Ⅱ组：50例，为小婴儿第2阶段；I／Ⅲ组：205例，为小婴儿第3阶段。新生儿病种分布中大动脉错位（D-TGA）最多，占57例（49．6％），小婴儿病种分布中VSD／PH，或同时伴有房间隔缺损（ASD）和PDA占104例（37．0％），其次为小婴儿D-TGA 54例（19．2％）。结果总住院死亡63例（15．9％），新生儿22例，小婴儿41例。N／Ⅰ组、N／Ⅱ组和N／Ⅲ组的病死率分别为33．3％、57．1％和6．3％，新生儿D-TGA和PA／IVS的病死率第3阶段最低。I／Ⅰ组、I／Ⅱ组和I／Ⅲ组的病死率分别为50．0％、22．0％和8．3％。I／Ⅲ组的D-TGA和PA／IVS病死率均明显高于N／Ⅲ组。结论对于复杂和危重先心病应该宣传积极采取早期手术措施，尤其是D-TGA和PA／IVS等疾病新生儿阶段的手术病死率明显低于小婴儿。对于出现心力衰竭和严重缺氧患儿的处理要有急诊手术的观念。通过强化围术期生命器官的保护提高手术生存率。
Objective The aim of the current study was to review our surgical managements of the congenital heart disease was reviewed in Shanghai Children＇s Medical Center. Methods From June, 1973 to May, 2004, 115 neonates and 281 young infants with congenital heart disease underwent surgical correction in Shanghai Children＇s Medical Center. The patients were divided into six groups according to their ages and time of operations. Group N/Ⅰ ： neonates managed between 1975 and 1990 （n = 15）, group NⅡ ： neonates managed between 1991 and 1999 （n = 21）, group NⅢ ： neonates managed between 2000 and 2004 （n = 79）, group I/Ⅰ ： infants managed between 1975 and 1990 （n = 26 ）, group I/Ⅱ ： infants operated between 1991 and 1999 （n = 50）, group I/Ⅲ ： infants between 2000 and 2004 （n= 205 ）. The most common diagnosis was D-TGA （49.6%, 57/115） in the neonates groups. There were 104 （37%） VSD/PH with or without ASD and PDA patients in the infants groups. The second most common diagnosis was D-TGA （n = 54, 19. 2%）. Results There were 63 death cases （15. 9%）, 22 in the neonates groups, and 41 in the infants groups respectively. The death rates in the group N/Ⅰ , N/Ⅱ and N/Ⅲ were 33.3%, 57. 1% and 6. 3%, respectively. The death rates in the group I/Ⅰ , I/Ⅱ and I/Ⅲ were 50. 0%, 22. 0% and 8. 3%, respectively. The death rates of D-TGA and PA/IVS in the infants groups were higher than those in the neonates groups. Condusions Earlier surgical intervention in some neonates and young infants with complicated and critical congenital heart disease may reduce the mortality rate.
出处
《中华小儿外科杂志》
CSCD
北大核心
2006年第4期177-181,共5页
Chinese Journal of Pediatric Surgery
关键词
新生儿
婴儿
心脏外科
手术方法
Neonate
Infant
Cardiovascular surgical procedures
