Liu Yuhang,Wen Ping,Liu Qilong,et al.Emergency and sub-emergency operations for congenital heart disease in 75 infants with a low age and a low body weight[J].Journal of Clinical Pediatric Surgery,2019,18(09):779-783.[doi:10.3969/j.issn.1671-6353.2019.09.015]
75例低龄低体重先心病急诊、亚急诊心内直视手术疗效分析
- Title:
- Emergency and sub-emergency operations for congenital heart disease in 75 infants with a low age and a low body weight
- Keywords:
- Heart Diseases/CN; Low Body Weight; Infant; Treatment Outcome
- 分类号:
- R726;R654.2
- 摘要:
- 目的 探讨6月龄以内体质量5 kg以下低体重婴幼儿先天性心脏病急诊、亚急诊心内直视手术的围手术期处理方法，并评估其干预效果。方法 以2014年1月至2017年4月于大连市儿童医院接受急诊、亚急诊心内直视手术治疗的6月龄以内、体质量5 kg以下的75例先天性心脏病患儿为研究对象。平均体重（4.2±0.8）kg，年龄6 h至6个月。接受根治性手术者69例，接受姑息性手术者6例。对患儿的临床资料、各项检查结果及治疗情况进行分析。结果 75例中住院死亡5例（6.67%），死亡原因：低心排综合综合征3例，重症感染1例，急性心包填塞1例。存活70例，均获随访，随访时间1~40个月。接受根治性手术后存活的64例中，室间隔缺损少量残余分流2例，主动脉弓血流速度加快2例，肺静脉吻合口血流速度加快1例，其余患儿均生长发育良好，心影缩小，肺动脉压正常；接受姑息手术的6例症状明显减轻，2例已顺利完成二期手术。结论 随着围术期管理、麻醉以及体外循环技术的提高，对6月龄以内、体质量5 kg以下低体重婴幼儿先天性心脏病实施急诊、亚急诊心内直视手术安全性较高，且疗效良好。
- Abstract:
- Objective To explore the perioperative management of emergency and sub-emergency open heart operations for congenital heart disease (CHD) in infants aged under 6 months with a low body weight of 5 kg or less.Methods From January 2014 to April 2017,emergency and sub-emergency open heart operations were performed for 75 CHD infants aged under 6 months of age with a body weight of (4.2±0.8) kg.Radical (n=69) and palliative (n=6) operations were performed.Results Among them,5 (6.67%) died in hospital due to low cardiac syndrome (n=3),severe infection (n=1) and acute pericardial tamponade (n=1).The remainders survived and were followed up for 1 to 40 months.Among 64 survivors of radical procedures,there were a small residual ventricular septal defect (n=2),aortic arch flow velocity (n=2) and accelerated blood flow velocity in pulmonary vein anastomosis (n=1).Cardiac silhouette narrowed and pulmonary artery pressure was normal.Six cases of palliative surgery were significantly relieved and 2 cases completed the second stage of surgery.Conclusion With the improvements of perioperative management,anesthesia,cardiopulmonary bypass and surgical techniques,emergency and sub-emergency open heart operations are both safe and efficacious for CHD infants aged under 6 months with a low birth weight of 5 kg.
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备注/Memo
收稿日期:2018-08-08。
通讯作者:文平,Email:13504115999@163.com