新生儿主动脉缩窄合并室间隔缺损27例一期手术矫治效果分析

目的探讨新生儿主动脉缩窄合并室间隔缺损一期手术矫治的效果。方法回顾性分析2015年1月至2018年12月湖南省儿童医院收治的主动脉缩窄合并室间隔缺损新生儿的临床资料,排除合并其它复杂心脏畸形的病例;所有患儿一期矫治主动脉缩窄,同期行室间隔缺损修补术,采用围手术期精细化管理,共27例患儿纳入本研究,日龄范围4~28 d,平均(20.1±6.9)d;体重2.7~4.5 kg,平均(3.6±0.5)kg。结果27例中,术后延迟关胸11例,出血6例,急性肾功能衰竭2例,乳糜胸1例,气胸2例,胸腔积液1例,心律失常2例,血压升高1例,再插管3例。严重低心排出量综合征并早期死亡1例,其余26例均经过精细化管理治愈出院。随访3~48个月,吻合口狭窄再手术1例,其余患儿复查结果均满意。结论新生儿主动脉缩窄合并室间隔缺损一期矫治手术效果良好,若术前乳酸已出现进行性升高会影响术后结局,围手术期精细化管理对提高手术成功率非常重要。

Analysis of the effect of one-stage surgical correction in 27 neonates with aortic constriction and ventricular septal defect

Objective To investigate the effect of one-stage surgical correction of neonatal aortic coarctation associated with ventricular septal defect.Methods A retrospective analysis was conducted,in which the clinical data of neonatal aortic coarctation associated with ventricular septal defect treated at Hunan Children's Hospital from January 2015 to December 2018.All patients underwent coarctation correction and ventricular septal defect repair.To eliminate other complex cardiac anomalies,the perioperative management had been taken,a total of 27 cases of newborn were included in the study,age range(4-28)d,average(20.1+6.9)d.Body weight range(2.7-4.5)kg,average(3.6±0.5)kg.Results There were 11 cases of postoperative delayed sternal closure,6 cases of postoperative hemorrhage,2 cases of acute renal failure,1 case with chylothorax,2 cases of pneumothorax,1 case of pleural effusion,2 cases of arrhythmia,1 cases of high blood pressure,3 cases of reintubation,1 death of severe low cardiac output syndrome.The rest of the 26 patients had been cured and discharged with postoperative fine management,and followed-up for 3-48 months.There was 1 case of anastomotic restenosis operation and the rest of the children were satisfied with the re-examination results.Conclusion The outcome of one-stage surgical correction of neonatal aortic coarctation associated with ventricular septal defect is satisfactory,but the progressive elevation of lactic acid before operation will affect postoperative outcome,and fine management of perioperative period is very important to improve the success rate of operation.