摘要
目的探讨新生儿复杂型先心病的临床特点和手术治疗效果。方法回顾性分析2004年1月至2006年12月诊断先心病并在本院进行了手术治疗的新生儿42例。均经超声心动图确诊,3例同时行CT检查。根据病情,术前进行了抗心衰、前列腺素E1等综合治疗,2例术前行房间隔造口术。随访结果依据门诊复查病历及电话随访,随访率97·2%,随访期限3～46个月。结果7d以内22例,占52·4%。除1例主动脉瓣狭窄的患儿外,都有不同程度的紫绀,经皮血氧饱和度30%～93%,9例(21·4%)重度青紫(SpO2≤65%)。依次诊断为完全性大动脉转位28例、完全性肺静脉异位引流7例、肺动脉闭锁5例、右室双出口1例、主动脉瓣重度狭窄1例。均实施了手术治疗。早期死亡6例,病死率14·3%。死亡原因为感染4例、冠状动脉血栓1例、肺静脉重度狭窄、肺泡发育不良1例。随访35例,1例失访,随访率97·2%,随访期限3～46个月,晚期死亡4例,1例行二次手术。存活患儿生长发育正常,心功能均为Ⅰ级,恢复良好。结论新生儿复杂型先心病多表现青紫,大多听不到杂音。发现新生儿青紫应做超声心动图排查,一旦确诊复杂型先心病,绝大部分需要及时手术,手术成功率较高,治疗效果较好。
Objective To study the clinical features and outcomes of 42 newborns who had undergone corrective surgery for severe congenital heart disease （CHD）. Methods Clinical data of 42 newborns diagnosed with CHD and underwent cardiac surgeries from January 2004 to December 2006 in the Hospital were analyzed retrospectively. The diagnosis was confirmed by echocardiogrphy in all cases and by muhidetector computed tomography （MDCT） simultaneously in 3 cases. The pre-operative preparations included administering cardiotonic, diuretic or PGE1 according to their conditions; 2 newborns received atrial septal detect enlargement. The follow-up was done by phone interviews and clinic visits including clinical evaluation, ECG, chest radiograph and echocardiography. 97.2% of patients were followed up for 3 to 46 months after operation. Results Twenty-two patients （ 52. 4% ） were admitted within the first week of their lives. Except for one patient with critical aortic stenosis （AS）, all other almost every patients had mild to severe cyanosis with pulse oxymetry 30% to 93%, 9 neonates （21.4%） were severely hypoxic （oxygen saturation ≤ 65 % ）. Twenty-eight patients diagnosed with complete transposition of the great arteries （TGA）, 1 with double outlet of right ventricle （DORV）, 7 with total anomalous pulmonary venous connection（ TAPVC）, 5 with pulmonary atresia （PAA） and 1 with AS. All patients underwent corrective surgeries, including arteries switch and concomitant repair of structural heart diseases for TGA and DORV, correction of TAPVC, balloon valvotomy plus BlalockTaussig shunt for 3 cases of PAA, Blalock-Taussig shunt only for 2 cases of PAA which had with right ventricle hypoplasia and aortic valvotomy for AS. Six babies died in early stage post-operation （mortality 14. 3% ）, 4 with TGA and 2 with TAPVC. Four out of 6 died of infection, 1 patient with TAPVC died of severe pulmonary venous stenosis and alveolar dysplasia and 1 died for coronary artery thrombosis after switching operation and coronary artery bypass grafting. The follow-up data showed there were 4 cases of late death, yielding an overall late mortality rate of 11.4% （4/35）. One patient with PAA and right ventricle hypoplasia received second operation half year after the initial B-T shunt. Conclusion Most of the critical CHD in newborns present with cyanosis and no audible murmur. Echocardiography should be performed for newborns with cyanosis. If critical CHD is confirmed, almost all of them should undergo operation as early as possible to achieve higher successful rate and better outcome.
出处
《中国新生儿科杂志》
CAS
2008年第3期129-132,共4页
Chinese Journal of Neonatology
基金
国家"十一五"基金项目(2006BAI01A08)
关键词
心脏病
胸外科手术
随访研究
Heart diseases
Thoracic surgical procedures
Follow-up
