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体质量小于5 kg心脏畸形患儿外科治疗的临床分析(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第5期
页码:
627-629
栏目:
临床研究
出版日期:
2008-10-20

文章信息/Info

Title:
Clinical analysis of cardiac operations in no more than 5 kilogram infants with heart anomalies
作者:
张金洲1; 王文2; 朱海龙1; 孙国成1; 崔勤1; 顾春虎1; 陈涛1; 易定华1
第四军医大学西京医院: 1.心血管外科,2.中医科，陕西 西安 710032
Author(s):
ZHANG Jinzhou1;  WANG Wen2;  ZHU Hailong1;  SUN Guocheng1;  CUI Qin1;  GU Chunhu1;  CHEN Tao1;  YI Dinghua1
1.Department of Cardiovascular Surgery, 2.Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
心脏病; 先天性; 婴幼儿; 外科手术
Keywords:
Heart disease;  Congenital infants;  Surgical operation
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
目的 总结低体质量（≤5 kg）心脏畸形患儿的外科治疗经验。方法 回顾我院从2005年4月～2006年11月连续收治116例体质量小于5 kg的心脏畸形患儿的临床资料，分析低体质量心脏畸形患儿的手术时机、风险因素及围手术期处理经验。结果 116例患儿平均年龄21 d~10月(79±50)d ，体质量2.4~5(3.6±1.1)kg。106例（91.4%）患儿在中低温体外循环下进行手术矫治，10例（8.6%）患儿在深低温停循环和选择性脑灌注下进行手术矫治。105例（90.5%）患儿痊愈出院，3例患儿明显好转，死亡8例（6.9%）。2例死于心功能衰竭，2例死于败血症，2例死于肾功能衰竭，1例死于多脏器功能衰竭，1例死于脑出血。术后早期并发症有：呼吸机延期辅助呼吸26例，肺部感染5例，伤口感染3例，膈肌麻痹2例，低血糖2例。呼吸机辅助平均时间8 h~21 d(19.2±6.7)h，ICU时间2~35(4.8±1.1)d 。结论 低体质量心脏畸形患儿手术矫治近期疗效满意，深低温停循环时间是影响手术死亡率的重要因素，体外循环时间与术后并发症的发生密切相关，外科矫治采用一期根治或是姑息手术应综合考虑近期与远期疗效，手术后治疗强调营养支持和呼吸道管理。
Abstract:
AIM To sum up the experiences of surgical managements in low weight infants (≤5 kg) with heart anomalies. METHODS We retrospectively reviewed the clinical data of consecutive 116 infants(≤5 kg) with heart anomalies in our institute, and to explore the optimal time of operations, risk factors and perioperative managements. RESULTS The average age of the 116 patients was (788±50)days（ranging 21 days-10 months） and the average weight was (356±11)kg (ranging 24-5 kg). Corrective operations were performed in 106 patients under mediate hypothermia with cardiopulmonary bypass, and 10（8.6%）cases underwent deep hypothermia circulatory arrest and selective brain perfusion. One hundred and five (90.5%) patients recovered and discharged, and 3 patients had improved symptoms. Eight children died (mortality 6.9%), two died of heart failure, two died of sepsis, two died of renal failure, one of multiple organ function failure and one of brain bleeding. Early postoperative complications were prolonged intubation in 26 children, pulmonary infection in 5, wound infection in 3, diaphragmatic paralysis in 2, and hypoglycemia in 2. The average length of intubation was 19.2 h（8 hs-21 days） and the average timing of ICU was 4.8 days（2-35 days）. CONCLUSIONS Satisfactory results can be obtained for corrective operations in low weight infants (≤5 kg) with congenital malformation. The length of deep hypothermia circulation arrest and cardiopulmonary bypass are the key factors affecting the prognosis. More attention should be given to nutritional support and respiratory administration in postoperative managements.

参考文献/References

［1］ Kecskes Z, Cartwright DW. Poor outcome of very low birthweight babies with serious congenital heart disease［J］. Arch Dis Child Fetal Neonatal Ed, 2002, 87(1):F31-F33.
［2］ Guido O, Carlo PN, Roberto F, et al. Outcome of cardiac surgery in low birth weight and premature infants［J］. Eur J Cardio thorac Surg, 2004, 26(1):44-53.
［3］ Thierry B, Katrien F, Katya DG, et al. Outcome analysis of major cardiac operations in low weight neonates［J］. Ann Thorac Surg, 2004, 78(1):181-187.
［4］ Wernovsky G, Rubenstein SD, Spray TL, et al. Cardiac surgery in the low birth weight neonate: new approaches［J］. Clin Perinatol, 2001, 28(1):249-264.
［5］ 张金洲，朱海龙，孙国成，等. 婴幼儿主动脉缩窄合并心内畸形的外科治疗［C］// 第六次全国胸心血管外科会议. 北京， 2006:11.
［6］ Einarson KD, Arthur HM. Predictors of oral feeding difficulty in cardiac surgical infants［J］. Pediatr Nurs, 2003, 29(4):315-319.

备注/Memo

备注/Memo:
收稿日期：2007-04-11.基金项目：国家科技支撑计划“11·5”课题资助（2006BAI01AOB） 通讯作者：易定华，教授，主任医师，主要从事冠心病、复杂先心病和心脏移植研究Email:yidh@fmmu.edu.cn 作者简介：张金洲，主治医师,博士Email:jinzhou@fmmu.edu.cn
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