摘要
目的总结低出生体重儿（LBWI）先天性心脏病（先心病）手术的围术期管理体会,分析其预后的危险因素。方法回顾分析22例低体重先心病手术病儿,出生体重855～2 500g,平均（2 168．41±416．16）g;孕26．57～40．43周,平均（36．23±3．00）周。手术年龄1～86d,平均（28．90±25．14）d,手术时体重1 790～3000 g,平均（2465．95±319．17）g。8例为非体外循环手术,14例为体外循环手术,常规改良超滤。结果5例病婴术毕延迟关胸。术后呼吸机支持,联合用药改善心功能。术后呼吸机使用5～1 080h;重症监护室滞留1～56 d;总住院12～85d。术后并发低心排出量综合征（LCOS）12例,肺部感染4例,肺动脉高压危象1例,房性早搏1例,左膈运动障碍1例。术后住院死亡3例,病死率13．64％,死因均为严重低心排出量综合征（LCOS）。单变量危险度分析显示,早产、低出生体重、导管依赖型先心病、复杂畸形和深低温信循环是发生LCOS或死亡的危险因素。结论LBWI先心病应早期手术,有利于减少因低氧血症和压力、容量负荷过重导致的器官功能二次损伤,从而提高术后生存率。
Objective To summarize the perioperative management of the low birth weight neonates with congenital heart disease and to evaluate the risk factors of cardiac surgery in these patients. Methods Twenty-two cases were included in this study. The mean birth weight, gestational age, age at operation and weight at operation were （2 168.41 ± 416.16）g （ranged from 855 to 2 500 g）, （36.23 ± 3.00）weeks （ranged from 26.57 to 40.43 weeks ）, （28.90±25.14） d （ranged from 1 to 86 d） and （2 465.95± 319.17） g （ranged from 1 790 to 3 000 g）, respeetively. Eight eases underwent the off-pump operation, and the other 14 cases underwent the operation by cardiopulmonary bypass （CPB）, which were given modified ultrafihration routinely. Five eases were delayed sternal closure after operation. All these 22 cases were given mechanical ventilation and were administered inotropic support, including Dopamine, Milrinone, Epinephrine and calcium. Results The mean time of postoperative mechanical ventilation was （200.67 ± 260.28） h （5 - 1 080 h）, the length of ICU stay was （11.89 ± 13.72） d （1 - 56 d）, the length of hospital stay was （33.53 ± 19.51） d （12 - 85 d）. Twelve patients developed LCOS （12/22, 54.5%） postoperatively. The other complications were pulmonary infection in 4 cases, pulmonary hypertension crises in 1 case, ardaythmia in 1 case and left diaphragmatic paralysis in 1 case. There were 3 hospital deaths with the mortality 13.64%. The main cause of death was severe low cardiac output syndrome. The mortality between Jan. 2000 and Dec. 2002 was 50% （3/6 cases）, which had significant difference with the mortality was 0 （0/16 cases） in the period of Jan. 2003 to Dec. 2005 year （ Х^2 = 9. 263, P = 0.013 ）. Univariate analysis showed premature, low birth weight, deep hypothermia cardiac arrest, ductus-dependent lesions and complex cases were the risk factors. However, age and weight at operation, palliative or corrective procedure, CPB and pulmonary hypertension did not influence mortality. Conclusion The advantage of early surgical intervention for the low birth weight neonates with congenital heart disease is to decrease the potential secondary effects of chronic cyanosis and of pressure and volume overload, which can decrease the mortality.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第2期80-83,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
