新疆地区107例低体质量婴儿先天性心脏病的外科治疗

目的:探讨新疆地区体质量5 kg以下少数民族婴儿,先天性心脏病(先心病)的外科治疗方法及围术期处理。方法:2006年7月至2011年12月,本院手术治疗5 kg以下先心病患儿107例,年龄11 d至13个月,体质量2.6～5 kg。病种包括:动脉导管未闭(PDA)4例,室间隔缺损(VSD)和(或)房间隔缺损(ASD)54例,其中部分伴动脉导管未闭(PDA)和(或)肺动脉高压(PH),肺动脉瓣狭窄(PS)1例,法洛三联症3例,法洛四联症(TOF)9例,完全性心内膜垫缺损(ECD)9例,右心室双出口(DORV)9例,完全性大血管转位(TGA)8例(室间隔完整4例,室间隔缺损4例),完全性肺静脉异位引流(TAPVC)3例,主动脉弓缩窄(COA)并室间隔缺损、房间隔缺损3例,肺动脉闭锁(PA)2例,三尖瓣闭锁(TA)1例,房室连接不一致1例。本组中I期根治手术96例,减状手术11例(肺动脉环缩术6例,中心分流术4例,右心室流出道疏通术1例);体外循环下手术93例,其中深低温停循环3例。结果:本组术后早期死亡6例(5.6%),死于低心排出量综合征(低心排)1例,多脏器衰竭2例,呼吸衰竭2例,凝血功能障碍1例。术后主要并发症:低心排9例,多脏器损害5例,肾衰竭3例,肺部感染28例,心律失常3例,切口感染3例,心包积液2例,残余分流1例及乳糜胸1例。随访2个月～5年,81例无中期死亡,再手术3例。结论:严格评估低体质量先心病患儿手术适应证和时机,加强围手术期处理,是提高治疗效果的关键。

Surgical treatment of congenital heart diseases in minority infant with body weight less than 5 kg in Xinjiang region

Objective:To report the experience of the surgical treatment of congenital heart diseases(CHD) in minority infants with body weight less than 5 kg in Xinjiang region.Methods: From June 2006 to December 2011,107 children with CHD,aged 11 days to 13 months and weighing between 2.6 kg and 5 kg,underwent surgical treatment.Defects included PDA in 4,ASD and/or VSD no/with other malformation in 54,PS in 1,trilogy of fallot in 3,TOF in 9,ECD in 9,DORV in 9,TGA in 8,TAPVC in 3,COA in 3,PA in 2,TA in 1,atrioventricular discordance in 1.There were 96 patients with corrective procedure,11 with palliative surgical treatment.Results: There were 6 early postoperative deaths(5.6%).The major causes of death were cardiac output in 1,multi-organ failure in 2,respiratory failure in 1,reduced coagulation in 1.The common complications included cardiac output in 9,multi-organ damage in 5,renal failure in 3,Lung infection in 28,arrhythmia in 3,wound infection in 3,pericardial effusion in 2,residual shunt in 1,ehymal chest in 1.Followed up for 2 month to 5 years,81 survivors had no midterm mortality or severe complications.Three survivors with palliative procedure undergo corrective operation.Conclusion: The surgical treatment was crucial to infants with CHD with body weight at the operation time and operation method.Good perioperative treatment can effectively reduce complications and mortality.