【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。更多还原

【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.更多还原