Yang Guangxian,Huang Peng,Liujian,et al.Surgical treatments and perioperative managements of neonatal critical congenital heart disease.[J].Journal of Clinical Pediatric Surgery,2018,17(03):212-218.
新生儿危重先天性心脏病的手术诊治及围术期处理探讨
- Title:
- Surgical treatments and perioperative managements of neonatal critical congenital heart disease.
- 文献标志码:
- A
- 摘要:
-
目的 总结本院新生儿危重先天性心脏病的手术经验及围术期处理体会，探讨新生儿危
重先天性心脏病的诊治方法。 方法 回顾性分析２０１４ 年１ 月至２０１７ 年９ 月本院心胸外科收治的６２
例新生儿危重先天性心脏病患儿的临床资料，其中男４７ 例，女１５ 例。病种构成：主动脉弓疾病２２ 例
（主动脉缩窄并室间隔缺损２０ 例，主动脉弓中断２ 例） ，完全性肺静脉异位引流１８ 例，大动脉转位１０
例，室间隔缺损并肺动脉高压８ 例，肺动脉狭窄３ 例，主动脉狭窄合并肺动脉狭窄１ 例，除１ 例肺动脉瓣
狭窄采用杂交手术以外，其余６１ 例均采用体外循环下根治手术治疗。 结果 ６２ 例中，痊愈出院５７
例，死亡６ 例，病死率为９． ７％ 。手术后采用延迟关胸２６ 例，术后出现心律失常８ 例，膈肌麻痹１ 例，坏
死性小肠结肠炎１ 例，少尿６ 例。 结论 新生儿危重先天性心脏病于早期采取积极有效的干预可获
得良好的效果。尽早诊断，合理把握手术时机，不断提高手术技术、体外循环技术及围手术期管理水平
是改善新生儿危重先天性心脏病预后的关键，建立新生儿先天性心脏病的医院间多学科协同网络救治
是今后发展的方向。
- Abstract:
- ObjectiveTo summarize the surgical experiences and perioperative managements of neonatal critical congenital heart disease (CCHD).MethodsFrom January 2014 to September 2017，clinical data were reviewed for 62 CCHD cases including 47 boys and 15 girls.The etiologies included aortic arch disease (n=22) (including 20 aortic coarctaions with ventricular septal defect and 2 interruptions)，total anomalous pulmonary venous drainage (n=18)，transposition of great arteries (n=10)，ventricular septal defect & pulmonary arterial hypertension (n=8)，pulmonary artery stenosis (n=3) and aortic stenosis with pulmonary artery stenosis (n=1).One case of pulmonary artery stenosis underwent hybrid procedure while the remainder had radical cardiac surgery by cardiopulmonary bypass.ResultsAmong them，57 cases were discharged while 5 cases died with a mortality rate of 9.7%.And 26 cases were treated by delayed sternal closures.Six cases received peritoneal dialysis.There were arrhythmia (n=8)，diaphragmatic palsy (n=1) and necrotizing enterocolitis (n=1).ConclusionEarly intervention for neonatal CCHD may achieve excellent outcomes.Early diagnosis，optimal timing of surgery，continuous improvements of surgical techniques，cardiopulmonary bypass technology and perioperative managements are essential for improving the prognosis of neonatal CCHD.Establishing a multidisciplinary collaborative network is a future trend.
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[2]邱永升,贾英萍,梁郑,等.先天性脐膨出、腹裂患儿的围术期管理[J].临床小儿外科杂志,2007,6(02):23.
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