婴儿复杂先天性心脏病外科治疗.docVIP

婴儿复杂先天性心脏病外科治疗 　 作者：乔彬，王同建，张锋泉，宁岩松，吴莉莉，朱萌 【摘要】 目的总结婴儿复杂先天性心脏病一期根治手术的效果。方法2001年 1月至 2005年 6月，手术治疗婴儿复杂先天性心脏病204例，男136例，女68例。年龄23h～12m(5.3±3.8)m。新生儿58例，1～3m 54例，3～6m 45例；体重1.5～13.5（6.2±2.2）kg，小于3 kg 10例，3.1～4 kg 23例，4.1～5 kg 32例，5.1～10 kg 134例，大于10 kg 5例。其中：法洛四联症（TOF）107例，合并肺动脉闭锁（PA）15例；大动脉转位（TGA）38例；完全性房室隔缺损（TECD）21例；主动脉弓中断（IAA）16例；完全性肺静脉异位连接（TAPVC）12例；永存动脉干（PTA）10例。全组均一期根治，急诊手术67例，择期手术137例。手术均在体外循环下完成，中度低温（26℃～28℃）110例，深低温（16℃～18℃）停循环67例，深低温低流量［50ml/（kg·min）］27例。结果本组早期（术后30 d）死亡15例（7.3％）。死亡原因：1例TGA主动脉吻合口出血， 另1例右冠状动脉损伤，余均为严重低心排和／或肾功能衰竭。术后主要并发症：低心排和／或肾功能不全、低钙血症、低氧血症、肺不张、感染。189例存活者随访 2～72个月：死亡1例，为心内型TAPVC患儿，术后1年因呼吸道感染在其他医院治疗过程中死亡，死因不详；右心功能不全1例，为Ⅰ型PTA患儿，出院后6m出现肝大、腹水，对症治疗一周后症状明显改善；余患儿心功能Ⅰ级168例、Ⅱ级19例。结论婴儿复杂先天性心脏病特别是呼吸循环不稳定和/或重度低氧血症者，一经确诊应及时手术。术前不利因素的积极纠治和精心的手术设计，为手术成功提供了有力保障。 【关键词】 心脏缺损；先天性心脏病；婴儿；外科手术 　　Surgical Therapy for Complicated Congenital Heart Disease in Infants 　　Abstract: OBJECTIVE To assess the effect of surgical treatment of complex congenital heart disease of infants. METHODSTwo hundreds and four infants(male 136,female 68) who had complex congenital heart disease were admitted and operated in our hospital from January 2001 to June 2006. Their ages ranged between 23 hours and 12 (mean 5.3±3.8) months. Their body weight ranged between 1.5 and 13.5 (mean 6.2±2.2)kg. The preoperative diagnosis included: tetralogy of Fallot(TOF) (107 cases), complete transposition of the great arteries(TGA) (38), total endocardial cushion defect (TECD)(21),interrupted aortic arch(16), total anomalous pulmonary venous connection (TAPVC)(12),and persistent truncus arteriosus(PTA)(10). All patients were operated one-stage, including 67 emergency operations and 137 selective operations. 110 operations under moderate hypothermia(temperature ranged from 26℃ to 28℃), 27 operations under deep hypothermia(temperature ranged from 16℃ to 18℃) and low flow (50ml/(kg·min)), and 67 operations under deep hypothermia circulation arrest. RESULTS15 death(7.3%) occurred in earlier postoperative pe