摘要
目的总结低体质量(≤5 kg)心脏畸形患儿的外科治疗经验。方法回顾我院从2005年4月~2006年11月连续收治116例体质量小于5 kg的心脏畸形患儿的临床资料,分析低体质量心脏畸形患儿的手术时机、风险因素及围手术期处理经验。结果116例患儿平均年龄21 d^10月(79±50)d,体质量2.4~5(3.6±1.1)kg。106例(91.4%)患儿在中低温体外循环下进行手术矫治,10例(8.6%)患儿在深低温停循环和选择性脑灌注下进行手术矫治。105例(90.5%)患儿痊愈出院,3例患儿明显好转,死亡8例(6.9%)。2例死于心功能衰竭,2例死于败血症,2例死于肾功能衰竭,1例死于多脏器功能衰竭,1例死于脑出血。术后早期并发症有:呼吸机延期辅助呼吸26例,肺部感染5例,伤口感染3例,膈肌麻痹2例,低血糖2例。呼吸机辅助平均时间8 h^21 d(19.2±6.7)h,ICU时间2~35(4.8±1.1)d。结论低体质量心脏畸形患儿手术矫治近期疗效满意,深低温停循环时间是影响手术死亡率的重要因素,体外循环时间与术后并发症的发生密切相关,外科矫治采用一期根治或是姑息手术应综合考虑近期与远期疗效,手术后治疗强调营养支持和呼吸道管理。
AIM To sum up the experiences of surgical managements in low weight infants （ ≤ 5 kg） with heart anomalies. METHODS We retrospectively reviewed the clinical data of consecutive 116 infants（ ≤5 kg） with heart anomalies in our institute, and to explore the optimal time of operations, risk factors and peri-operative managements. RESULTS The average age of the 116 patients was （78. 8 ± 50） days（ranging 21 days- 10 months） and the average weight was （3.56 ± 1.1 ） kg （ranging 2.4- 5 kg）. Corrective operations were performed in 106 patients under mediate hypothermia with cardiopulmonary bypass, and 10 （8.6%）cases underwent deep hypothermia circulatory arrest and selective brain perfusion. One hundred and five （90. 5% ） patients recovered and discharged, and 3 patients had improved symptoms. Eight children died （ mortality 6.9% ）, two died of heart failure, two died of sepsis, two died of renal failure, one of multiple organ function failure and one of brain bleeding. Early postoperative complications were prolonged intubation in 26 children, pulmonary infection in 5, wound infection in 3, diaphragmatic paralysis in 2, and hypoglycemia in 2. The average length of intubation was 19.2 h（8 hs -21 days） and the average timing of ICU was 4. 8 days （2 - 35 days）. CONCLUSIONS Satisfactory results can be obtained for corrective operations in low weight infants （ ≤ 5 kg） with congenital malformation. The length of deep hypothermia circulation arrest and cardiopulmonary bypass are the key factors affecting the prognosis. More attention should be given to nutritional support and respiratory administration in postoperative managements.
出处
《心脏杂志》
CAS
2008年第5期627-629,共3页
Chinese Heart Journal
基金
国家科技支撑计划"11.5"课题资助(2006BAI01AOB)
关键词
心脏病
先天性
婴幼儿
外科手术
Heart disease
Congenital infants
Surgical operation
