Shi Lei,Zhai Bo,Yang Fang,et al. Emergency primary repair of critical congenital heart disease in neonates and infants.[J].Journal of Clinical Pediatric Surgery,2018,17(12):931-934.
婴幼儿危重先天性心脏病急诊根治手术时机的初步探讨
- Title:
- Emergency primary repair of critical congenital heart disease in neonates and infants.
- Keywords:
- ; Heart Disease/CN; Emergency; Critical; Infant; Primary Repair
- 文献标志码:
- A
- 摘要:
- 目的探讨婴幼儿危重先天性心脏病的急诊手术治疗时机和效果。方法郑州儿童医院于2016年1月至2017年2月共实施192例急诊先天性心脏病矫治手术，包括室间隔缺损合并肺动脉高压113例，主动脉缩窄合并室间隔缺损21例，完全性大动脉转位13例，完全性肺静脉异位引流13例，右室双出口伴肺动脉高压10例，动脉导管未闭合并肺动脉高压8例，重症法洛四联征6例，主动脉弓离断合并室间隔缺损5例，重度肺动脉瓣狭窄3例。手术年龄3 d至14个月。术前患儿由于难治性肺炎合并心力衰竭及肺动脉高压或难以纠正的低氧血症、酸中毒，经积极术前准备，于24 h内行一期根治术。结果192例中，治愈183例，死亡9例，病死率4.68%，原发病为室间隔缺损合并肺动脉高压4例（1例放弃治疗），完全性大动脉转位2例，主动脉缩窄合并室间隔缺损1例，完全性肺静脉异位引流1例，主动脉弓离断合并室间隔缺损1例。其余病例并发症与择期手术相似，包括出血、残余分流、残余梗阻、肺动脉高压危象、低心排出综合征、心律失常、肺部感染、胸腔积液、乳糜胸、败血症、膈肌麻痹等，经治疗均治愈出院。结论婴幼儿危重先天性心脏病的急诊手术虽然风险较大，但是手术死亡率仍然较低，心衰严重和濒死患儿并不是手术绝对禁忌证，急诊手术治疗仍有必要。
- Abstract:
- ObjectiveTo explore the surgical outcomes and timing of emergency primary repair of critical congenital heart disease.MethodsA total of 192 neonates and infants with critical congenital heart disease were recruited for emergency primary surgery from January 2016 to February 2017.There were ventricular septal defect plus pulmonary hypertension (VSD/PH)(n=113),coarctation of the aorta (COA) plus VSD (n=21),complete transposition of great arteries (TGA) (n=13),total anomalous pulmonary venous connection (TAPVC) (n=13),double outlet right ventricle (DORV) plus PH (n=10),patent ductus arteriosus (PDA) plus PH (n=8),critical tetralogy of Fallot (TOF,n=6),interruption of aortic arch (IAA) plus VSD (n=5) and severe pulmonary stenosis (PS,n=3).Operative age ranged from 3 days to 14 months.Because of refractory pneumonia complicated with heart failure or hypoxemia,correction of acidosis was difficult.After active preparation,emergency primary operation was performed within 24 h. ResultsNine children died with an overall inhospital mortality of 4.68%.There were VSD/PH (n=4,1 declined further treatment),TGA (n=2),COA/VSD (n=1),TAPVC (n=1) and IAA/VSD (n=1).Other complications were similar to those of selective operations.After treatment,the remainders were all cured. ConclusionDespite high risks,emergency primary repair is still efficacious for neonates and infants with critical congenital heart disease.Severe heart failure and even lethal condition are not absolute surgical contraindications.Wider popularization is recommended.
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