64例10公斤以下婴幼儿先天性心脏病的外科治疗

目的总结10kg以下婴幼儿先天性心脏病的外科治疗经验。方法回顾2009年10月至2012年10月64例10kg以下婴幼儿先天性心脏病的围术期治疗。患儿年龄3个月至3岁，平均8．8个月，体重5-10kg，平均7．6kg。8例全麻下手术，56例在全麻低温体外循环下行心脏畸形矫正术。体外循环手术的患儿术中全部采用超滤技术，术后ICU常规监护。结果全组体外循环转机时间42-189（98．5±45．6）min。阻断时间23-158min，ICU住院时间2～38d，呼吸机使用时间（89．63~40．24）h。围手术期死亡1例，占1．56％，死亡原因为低心排血综合征。其他并发症：肺部感染6例，肺不张8例，延迟关胸1例，出血2例，室间隔残余分流3例，室上性心动过速3例，Ⅲ度房室传导阻滞1例。结论提高体外循环水平，选择合适的手术时机和手术方法，加强术后治疗可以减少婴幼儿心脏手术的并发症，降低死亡率。

Surgical treatment of congenital heart disease in 64 infants with a weight of less than 10 kg

Objective To summary the surgical treatment experiences of infants with congenital heart dis- ease and weight lower than 10 kg. Methods A total of 102 infants weighting lower than 10 kg with congenital heart disease, which undergone heart operation between October, 2009 and October, 2012, were retrospectively summarized. Children aged 3 months to 3 years old, with an average of 8.8 months, weight 5-10 kg, the average 7.6 kg. In 8 cases under general anesthesia in general anesthesia operation, 56 cases performed under hypothermlc extracorporeal circulation cardiac malformation correction surgery, extracorporeal circulation operation patients in all patients by using ultra.filtration technology, ICU postoperative routine care. Results The total cardiopulmonary by- pass turnaround time was 42-189 rain, average of （98.5＋45.6）min, 23-158 min ICU staying time, hospitalization time of 2-38 days, ventilation time （89.63±40.24） hours peri-operation period, 1 cases of death （1.56%）, the cause of death was low cardiac blood syndrome. Other complications, pulmonary infection in 6 cases, 8 cases of at- electasis, delayed sternal closure in 1 cases, bleeding in 2 cases, ventricular septal residual shunt in 3 cases, supraventricular tachycardia 3 cases of heartbeat, three degree atrioventricular block in 1 cases. Conclusion Car- diopulmonary bypass level, appropriate operation time and operation method, postoperative treatment are very impor- tant in reducing the complications in infants undergoing cardiac operation.