小儿危重先天性心脏病急诊手术250例报告

目的 总结小儿危重先天性心脏病急诊手术的经验，探讨急诊手术的必要性和降低围手术期死亡和并发症的措施。方法 回顾分析1998年1月－2001年10月急诊手术治疗小儿危重先天性心脏病250例。男176例，女74例；术前反复呼吸道感染、心力衰竭或呼吸衰竭者121例，严重低氧血症者120例，其他危重患儿共9例；不用体外循环手术22例（36例次），常温平行体外循环20例，中度低温体外循环165例，深低温低流量或停循环43例。根治手术233例，姑息手术17例。结果 全组术中死亡12例，早期死亡18例，总病死率为12.0%(30/250)。存活的220例中术后主要并发症包括残余病变、重要脏器功能不全、感染和呼吸机依赖等。结论 急诊手术是挽救小儿危重先心病的有效手段，准确诊断、快速转运以及正确、合理的体外循环和手术方法降低手术对重要脏器的损害是提高手术成功率的关键。

Emergency operation on critical congenital heart defects in children a report of 250 cases

Objective To evaluate the importance in emergency operation and methods to decrease perioperative mortality and morbidity of critical congenital heart defects (CHD) in children. Methods The data of emergency operation on 250 patients (male 176, female 74) were retrospectively reviewed from January 1998 to October 2001. The presentations were recurrent respiratory infection accompanied with congestive heart failure or respiratory failure (121 cases), severe hypoxemia (120) and other critical conditions (9). The patients who underwent emergency operation without CPB were in 36 cases, on normothermic cardiopulmonary bypass (CPB) without aortic cross-clamping were in 20 cases, moderate hypothermic CPB 165 and deep hypothermic CPB with circulatory arrest or low flow rate 43. The emergency operation included reparative procedure (n=233) and palliative procedure (n=17). Results Twelve patients died on the table and 18 died after operation with a mortality of 12% (30/250). The common postoperative complications of the 220 survivors included residual lesions, dysfunction of multiple organs, infection and ventilator dependence. Conclusions Emergency operation can be performed with acceptable risk on those patients with critical congenital heart defects. Accurate diagnosis, rapid transport, proper CPB management and rational operations are very important to ensure the successful outcome.