摘要
目的评价低体重儿和早产儿先天性心脏病外科治疗的效果。方法2001年1月至2005年3月、完成36例低出生体重儿心脏手术。孕期31～40周，平均34周，其中24例为早产儿，出生体重700～2500g，平均2010g。手术时日龄4～68d，平均15．5d；手术时体重900～2500g，平均2120g。动脉导管未闭15例，室间隔缺损10例，肺动脉闭锁5例，主动脉缩窄3例，完全性肺静脉异位引流2例，完全性大动脉错位l例。18例需要在体外循环下手术。结果4例（11．1％）术后早期死亡。体外循环72～198min，平均（99±31）min；主动脉阻断46～158min，平均（76±18）min；深低温停循环6～35min，平均（19±8）min；术后机械通气12～240h，平均（74．4±96．2）h。8例术后并发症，2例需再手术或介入治疗。结论早产儿或低体重儿实施简单或复杂的先心病手术都是安全和有效的；低体重儿可实施早期手术治疗；对强心、利尿等心功能支持治疗效果不佳的病例早期实施根治性手术效果优于延期手术或减状手术。
Objective To evaluate the outcomes of cardiac surgery in neonates weighing less than 2500g and premature infants. Methods From January 2000 through March 2005, 36 consecutive critically symptomatic neonates （26 males, 10 females） weighing less than 2500g underwent cardiac surgery at our center. Median gestational age was 34 weeks with 24 （70.6%） premature （ ≤37 weeks）. Median age at operation was 15.5 days （from 4 days to 68 days）. Median weight was 2120g （from 700g to 2500g）. Indicatious for surgery were： persistent ductus arteriosns （ PDA, n = 15）, coarctation of the aorta （ CoA, n = 3）, transposition of great arteries with severely hypoplastic aortic arch （TGA/HAA, n = 1 ）, ventricular septal defect （VSD, n = 10）, pulmonary atresia with intact ventrictdar septum （PA/IVS, n = 5）, total abnormal pulmonary venous return （TAPVR, n = 2）. The heart functions of all patients were assessed in NYHA class Ⅳ and 7 patients （19.4%） were intubated pre-operatively. 18 cases （50%） needed extraeorporeal circulation and deep hypothermia with circulatory arrest was used in 6 patients. Results The overall mortality was 11.1%. The causes of death were left heart failure in 1 patient and multiorgan failure in 2 and hypoxmia in 1. Mean extracorporeal cireulatiou time was 92 min （from 72 min to 198 min）. Mean aortic cross-clamping time was 76 min （from 46 min to 158 min）. Mean deep hypothermia with circulatory arrest Peritoneum dialysis was carried out in 5 cases. Mean follow-up period was 22. 3 months （ from 2 months to 46 months）. 2 patients underwent reoperatiou and catheter intervention respectively. The heart functions of 26 patients （81.4%） were in NYHA class I at the latest clinical examination. Conclusion This study suggests that complete repair of simple and complex congenital heart diseases can be performed effectively in low birth weight neonates with acceptable mortality and morbidity. Low weight alone should not be considered as a contraindieafion
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2006年第6期378-380,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏缺损
先天性
婴儿
出生时低体重
婴儿
早产
心脏外科手术
Heart defects, congenital Infant, low birth weight Infant, premature Cardiac surgical procedure
