婴幼儿危重先天性心脏病的急诊手术

目的探讨婴幼儿危重先天性心脏病急诊手术的适应证、手术技术和围术期处理。方法2000年10月至2006年10月为128例危重先天性心脏病婴幼儿施行急诊或亚急诊手术；年龄7d～36个月。平均（4．8±1．6）个月；体重2．5～12．8kg，平均（5．8±2．4）kg；术前反复呼吸道感染、心力衰竭及呼吸衰竭109例，严重低氧血症19例；根治手术123例，姑息手术5例。结果全组住院死亡12例。9例死于术后低心排血量综合征（2例为完全型大动脉转位。行大动脉调转术；2例为法洛四联症及2例室隔完整型肺动脉闭锁；1例完全性肺静脉异位引流及2例室间隔缺损合并重度肺高压）。3例室间隔缺损合并重度肺高压，均为术前反复发生肺炎、心力衰竭，术后脱离呼吸机困难。死于呼吸衰竭和肺部感染。其余患者均治愈。结论婴幼儿危重先天性心脏病急诊、亚急诊外科治疗是可行的，可以挽救大部分患者的生命，正确、适时修复心脏畸形，恢复合理的血流动力学是提高手术成功率的关键。

Emergency operation on critical congenital heart disease in infants

Objective To study the indication and technology of emergency operation on critical congenital heart disease in infants and methods to perioperative treatments. Methods From October 2000 to October 2006,128 infants with critical congenital heart disease （86 male,42 females） were subjected to emergency operation. The age of the infants was 7 days - 36 months （ mean 4. 8 ± 1.6 months） and the weight was 2.5 ～12.8 kg （ mean 5.8 ± 2.4 kg）. The presentations were recurrent respiratory infection accompanied with congestive heart failure or respiratory failure （109 cases） and severe hypoxemia （ 19 cases）. The emergency operation included radical operation （n = 123 ） and palliative operation （n = 5 ）. Resnits The operative mortality was 9.3% （ 12/128 ）, including 9 cases of low cardiac output syndrome and 3 respiratory failure. Conclusion The emergency operation on critical congenital heart disease infants is safe. A complete heart defect repair and normal hemodynamics recovery are important measures to rescure infants from critical congenital heart disease.