低月龄低体重先天性心脏病的外科治疗
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摘要
<正>合并先天性心脏病(先心病)的低月龄、低体重患儿外科治疗一直是临床治疗的难题。随着心脏外科技术、麻醉、心肌保护和体外技术的不断提高,先心病治疗逐渐趋向低龄化和复杂化[1-3]。近年来,随着心脏外科技术的发展、心肌保护技术和麻醉技术的提高,低月龄、低体重先心病手术例数逐渐增加[1]。现对我院228例年龄小于≤6个月且体
Two hundred twenty-eight cases of age less than 6months or less and weight 10 kg or less with congenital heart disease undergoing surgical repair from October 2010 to April 2014 were analyzed retrospectively in Cardiac Surgery Department,the First Hospital of Hebei Medial University.All the patients received surgical repair under general anesthesia,including 19 patients without cardiopulmonary bypass(CPB)and 209 patients with CPB.A radical procedure was performed in 217 patients,and a palliative surgery was performed in 11 cases.Urgent operations were performed in all patients and no death occurred during surgery.Nine cases died after operation,the death rate was 3.94%.All survival patients were followed up from 3months to 3years.As a result,postoperative cardiac function improved significantly.Surgical repair for low months and low weight infants with congenital heart disease is safe and effective.Surgical technical experience accumulation and the improvement of postoperative care can help further reduce the incidence of complications.
Two hundred twenty-eight cases of age less than 6months or less and weight 10 kg or less with congenital heart disease undergoing surgical repair from October 2010 to April 2014 were analyzed retrospectively in Cardiac Surgery Department,the First Hospital of Hebei Medial University.All the patients received surgical repair under general anesthesia,including 19 patients without cardiopulmonary bypass(CPB)and 209 patients with CPB.A radical procedure was performed in 217 patients,and a palliative surgery was performed in 11 cases.Urgent operations were performed in all patients and no death occurred during surgery.Nine cases died after operation,the death rate was 3.94%.All survival patients were followed up from 3months to 3years.As a result,postoperative cardiac function improved significantly.Surgical repair for low months and low weight infants with congenital heart disease is safe and effective.Surgical technical experience accumulation and the improvement of postoperative care can help further reduce the incidence of complications.
引文
[1]杨思源,陈树宝.小儿心脏病学[M].北京:人民卫生出版社,2012:344-426.
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[3]王晟,梁杰贤,陈萍.低出生体重儿及早产儿先天性心脏病手术的麻醉处理[J].临床麻醉学杂志,2012,28(10):954-957.
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[8]吴永涛,李磊,范祥明,等.主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用[J].中华胸心血管外科杂志,2013,29(3):140-142.
[9]FANG M,WANG H,JIN Y,et al.Development of Pulmonary Arteries after a Central End-to-Side Shunt in Patients with Pulmonary Atresia,Ventricular Septal Defect,and Diminutive Pulmonary Arteries[J].Thorac Cardiovasc Surg,2014,62:211-215.
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[11]曾嵘,庄建,陈寄梅,等.低出生体重儿及早产儿心脏手术的早期疗效分析[J].中国胸心血管外科临床杂志,2012,19(6):227-231.
[12]汪丽,皮名安,龚立,等.小于6月龄的先天性心脏病患婴术后早期拔管策略及结果[J].中华胸心血管外科杂志,2013,29(1):37-39.
[13]KIN N,WEISMANN C,SRIVASTAVA S,et al.Factors affecting the decision to defer endotracheal extubation after surgery for congenital heart disease:aprospective observational study[J].Anesth Analg,2011,113:329-335.
[14]陆丽丽.低体重先心病直视术后监护体会[J].中国医学创新,2012,9(4):64-66.
[15]曾嵘,朱卫中,王晟,等.60例低出生体重新生儿及早产儿心脏手术术后监护治疗[J].中华小儿外科杂志,2012,33(8):589-592.
[16]LAWRENCE E J,NGUYEN K,MORRIS S A,et al.Economic and safety implications of introducing fast tracking in congenital heart surgery[J].Circ Cardiovasc Qual Outcomes,2013,6:201-207.
[2]丁晓晨,董培青.紫绀型先天性心脏病患儿的体外循环再氧合损伤[J].中华胸心血管外科杂志,2013,29(9):532-536.
[3]王晟,梁杰贤,陈萍.低出生体重儿及早产儿先天性心脏病手术的麻醉处理[J].临床麻醉学杂志,2012,28(10):954-957.
[4]SEO D M,PARK J J,YUN T J,et al.The outcome of open heart surgery for congenital heart disease in infants with low body weight less than 2500g[J].Pediatr Cardiol,2011,32:578-584.
[5]袁家,黄萍,陈欣欣,等.复杂型先天性心脏病大型主-肺动脉侧支血管的形态学特征[J].中华胸心血管外科杂志,2013,29(8):449-453.
[6]MYERS J W,GHANAYEM N S,CAO Y,et al.Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg:Analysis of shunt type,size,and surgical approach[J].J Thorac Cardiovasc Surg,2014,147:672-677.
[7]MCMULLAN D M,PERMUT L C,JONES T K,et al.Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow[J].J Thorac Cardiovasc Surg,2014,147:397-401.
[8]吴永涛,李磊,范祥明,等.主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用[J].中华胸心血管外科杂志,2013,29(3):140-142.
[9]FANG M,WANG H,JIN Y,et al.Development of Pulmonary Arteries after a Central End-to-Side Shunt in Patients with Pulmonary Atresia,Ventricular Septal Defect,and Diminutive Pulmonary Arteries[J].Thorac Cardiovasc Surg,2014,62:211-215.
[10]MAINWARING R D,SHEIKH A Y,PUNN R,et al.Surgical outcomes for patients with pulmonary atresia/major aortopulmonary collaterals and Alagille syndrome[J].Eur J Cardiothorac Surg,2012,42:235-240.
[11]曾嵘,庄建,陈寄梅,等.低出生体重儿及早产儿心脏手术的早期疗效分析[J].中国胸心血管外科临床杂志,2012,19(6):227-231.
[12]汪丽,皮名安,龚立,等.小于6月龄的先天性心脏病患婴术后早期拔管策略及结果[J].中华胸心血管外科杂志,2013,29(1):37-39.
[13]KIN N,WEISMANN C,SRIVASTAVA S,et al.Factors affecting the decision to defer endotracheal extubation after surgery for congenital heart disease:aprospective observational study[J].Anesth Analg,2011,113:329-335.
[14]陆丽丽.低体重先心病直视术后监护体会[J].中国医学创新,2012,9(4):64-66.
[15]曾嵘,朱卫中,王晟,等.60例低出生体重新生儿及早产儿心脏手术术后监护治疗[J].中华小儿外科杂志,2012,33(8):589-592.
[16]LAWRENCE E J,NGUYEN K,MORRIS S A,et al.Economic and safety implications of introducing fast tracking in congenital heart surgery[J].Circ Cardiovasc Qual Outcomes,2013,6:201-207.