低体重婴幼儿先天性心脏病的外科治疗

目的总结低体重婴幼儿先天性心脏病外科手术的经验。方法自2000年1月～2004年12月共为133例15公斤以下的低体重婴幼儿(3岁以下)先天性心脏病患儿施行外科手术治疗;其中5～12个月32例(24.1%),13～24个月46例(34.59%),25～36个月55例(41.35%);体重6～15公斤,其中6～10公斤48例,11～15公斤85例。全组非体外循环动脉导管结扎术29例;体外循环手术104例,其中室间隔缺损修补术64例,常温心脏不停跳继发孔房间隔缺损修补术16例,常温心脏不停跳肺动脉瓣狭窄直视分离术7例,部分行房室间隔缺损矫治术2例,部分行肺静脉异位引流矫治术3例,法乐氏四联症一期矫治术5例,房间隔缺损并右室流出道梗阻4例,其它复合畸形一期矫治术3例。结果全组术后住院死亡6例,死亡率4.5%。术后主要并发症包括低心排综合征,呼吸衰竭,心律失常,肺部感染,出血等。死亡原因包括重度低心排综合征,严重室性心律失常,肺动脉高压危象等。结论心外科、心儿科、麻醉、体外循环和术后监护等人员的密切配合是小儿心脏外科迅速发展的重要前提,心内外科镶嵌治疗成为婴幼儿心脏外科手术成功的重要保证。

SURGICAL TREATMENT OF CONGENITAL HEART DEFECTS IN SMALL INFANTS

Objective To summarize experiences in surgical correction of congenital heart defects in small infants. Method From January 2000 to December 2004, 133 cases of small infants, aged 5～12 months old (6～15 kg), with congenital heart defects, including patent ductus arteriosus, ventricular septal defect, atrial septal defect, pulmonary valve stenosis, partial atrial ventricular septal defect, partial abnormal pulmonary venous drainage, tetralogy of Fallot, atrial septal defect and right ventricular outflow tract obstruction et al, undergone cardiac defect corrections in this hospital. Result The post-operative mortality was 4.5% (6/133). The leading post-operative complications included low cardiac output syndrome, respiratory failure, arrhythmia, pulmonary infection, hemorrhage etc. The dead causes included serious low cardiac output syndrome, serious ventricular arrhythmia, worsened pulmonary hypertension etc. Conclusion Besides the progress in surgical manipulation technique, close cooperation between associated subjects, including cardiac surgery, pediatric cardiology, anesthesiology and ICU nursing staff, becomes an important premise for the rapid advancement in cardiac surgery. Mosaic treatment with cardiology and surgery ensures the success of cardiac surgery in infants.