10kg以下婴幼儿先天性心脏病合并肺动脉高压的外科治疗

目的探讨低体重婴幼儿先天性心脏病合并肺动脉高压的手术前准备、手术方法、体外循环管理和术后处理的注意事项,以减少婴幼儿先心病术后并发症的发生。方法回顾性分析22例10kg以下先心病合并肺动脉高压（pH）婴幼儿在体外循环（CPB）下行心内直视手术的围手术期处理临床资料。结果22例患儿年龄11～26月,平均（19.4±8.5）月;体重5.5～10.0kg,平均（7.6±2.3）kg;室间隔缺损（VSD）20例,其中合并房间隔缺损（ASD）2例,ASD合并动脉导管未闭（PDA）2例;肺动脉高压轻度8例,中度11例,重度3例。所有患儿均手术一期矫治,彻底纠正心内畸形,CPB转流时间32～110min,平均58min;主动脉阻断时间11～30min,平均22min;心脏全部自动复跳,均顺利脱机;l例因术后低心排综合征死亡,病死率4.5%,余均康复出院,无并发症发生。结论婴幼儿先心病合并肺动脉高压者应充分做好手术前准备工作,手术操作熟练,重视体外循环管理、围手术期处理,尤其是新技术、新药的合理应用,都有助于提高婴幼儿心脏手术的成功率,减少术后并发症的发生。

Retrospective study of infants less than 10 kg of body weight with congenital heart diseases associated with pulmonary hypertension undergoing open heart surgery

Objective To summarize the experience of peri-operative management of low weight infants with congenital heart diseases associated with pulmonary hypertension undergoing open heart surgery.Methods Clinical data of 22 infants less than 10 kg of body weight with congenital heart diseases with pulmonary hypertension undergoing open heart surgery were analyzed retrospectively.Results The patients＇ age was 11~26 months（Mean age：19.4土8.5 months）and the weight was 5.5~10 kg（Mean weight：7.6土2.3 kg）.Among the 22 patients,20 patients were found ventricular septal defect（2 patients were associated with Atrial Septal Defect and other 2 patients,patent ductus arteriosus）;Eight patients were suffered from mild pulmonary hypertension,11patients,moderate pulmonary hypertension,and 3 patients,severe pulmonary hypertension.All the patients were under single stage repair operation to correct the abnormalities.Bypass time was 32~110 min（Mean time：58 min）,and aortic cross-clamping time was 11~30 min（Mean time：22 min）.All the patients recovered heart beat automatically and weaned from CPB successfully.Twenty-one patients recovered well and discharged without complications except one patient died of postoperative low cardiac output syndrome.The mortality was 4.5%（1/22）.Conclusion Early surgical treatment was crucial to infants with congenital heart disease associated with pulmonary hypertension at appropriate time.Optimizing preoperative preparation,skilled surgical technique,emphasis on CPB and postoperative management,and introduction of new drugs and techniques may help improve the success rate of heart operations and reduce the opportunity of complications.