低出生体重儿及早产儿心脏手术的早期疗效分析

目的分析60例先天性心脏病(先心病)低出生体重儿(low birth weight infant)和早产儿行外科手术治疗的早期疗效。方法回顾性分析自2003年5月至2011年10月广东省心血管病研究所60例患先天性心脏病的低出生体重儿(体重2 500 g)和早产儿施行心脏手术治疗的临床资料,其中男43例,女17例;年龄4～55(24.9±12.5)d;孕周26～42(33.5±4.1)周,其中47例为早产儿;出生时体重640～2 500(1 729.3±522.5)g,手术时体重650～2 712(1 953.2±463.6)g。术前所有患者均在新生儿重症监护病房(NICU)接受治疗,在全身麻醉下行先心病矫治手术,其中行非体外循环手术29例,体外循环手术31例。术后住NICU进行监护治疗,并观察并发症发生情况和死亡情况。结果住院期间共死亡13例,总病死率为21.7%(13/60)。其中术中死亡4例,术后早期(72 h内)死亡6例,放弃治疗3例。体外循环时间(121.0±74.7)min,升主动脉阻断时间(74.8±44.7)min,术后呼吸机辅助呼吸时间(136.9±138.1)h。术后延期关胸13例,床旁开胸探查止血8例,发生重症肺炎10例,肺动脉高压危象2例,低心排血量综合征8例,均经相应的治疗治愈或好转。随访47例,随访时间2～12个月,患者均生存。结论对危重先心病低出生体重儿或早产儿早期施行外科手术治疗是安全、有效的。

Early Outcome of Open Heart Surgery for Congenital Heart Diseases in Low Birth Weight Infants and Premature Infants

Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants.Methods Sixty low birth weight infants(body weight<2 500 g) and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute.There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks(ranging from 26 to 42 weeks) and mean age at operation of 24.9±12.5 d(ranging from 4 to 55 d).Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g(ranging from 640 to 2 500 g) and mean weight at operation of 1 953.2±463.6 g(ranging from 650 to 2 712 g).All the patients received preoperative treatment in newborn intensive care unit(NICU) and underwent surgical repair under general anesthesia,including 29 patients without cardiopulmonary bypass(CPB) and 31 patients with CPB.All surviving patients received postoperative monitoring and treatment in NICU,and their postoperative complications and in-hospital death were reported.Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7%(13/60),including 4 intra-operative deaths,6 early deaths(within 72 h postoperatively) and 3 patients giving up postoperative treatment.CPB time was 121.0±74.7 min,aortic clamp time was 74.8±44.7 min,and postoperative mechanical ventilation time was(136.9±138.1) h.Thirteen patients underwent delayed sternal closure.Eight patients underwent reexploation for postoperative bleeding.Ten patients had severe pneumonia,2 patients had pulmonary hypertensive crisis,and 8 patients had low cardiac output syndrome.All the postoperative complications were resolved or improved after proper treatment.Follow-up was complete in 47 patients from 2 to 12 monthes,and all the patients were alive during follow-up.Conclusion Early surgical repair for low birth weight infants and premature infants with congenital heart diseases is safe and effective.