新生儿重症复杂性先天性心脏病手术疗效的影响因素

摘要

Objective To analyze the influencing factors of surgical management for neonatal complicated congenital heart disease(CCHD),sumarize the clinical experience and improve the surgical effect.Methods The clinical data of 154 neonates with complicated congenital heart disease who were undergone surgical management from August 2008 to August 2013 were retrospectively analysed.Results There were 14 cases of death with a mortality rate of 9.1％ (14/154),including 4 cases of preoperative death.The operative motality is 6.7％ (10/150),including 3 cases of single malformations(D-TGA/VSD,PA/VSD,IAA),and 7 cases of multiple malformation(HRHS/PS in 2,D-TGA/COA in 1,D-TAG/PS in 1,COA/SV in 1,SV/PA/IVS in 1 and D-TGA/COA/SV in 1).140 cases accepted regular follow-up after hospital discharge from 3 months to 5 years,8 of them underwent secondary surgery and all survived.Conclusion Timely diagnosis,actively improvement for preoperative internal environment,fine operative technique,individual cardiopulmonary bypass and intensive postoperative care are all important influencing factors of surgical effect for neonatal severe complicated congenital heart disease.%目的 分析影响新生儿重症复杂性先天性心脏病治疗的因素,总结治疗经验,以期提高手术疗效.方法 回顾性分析2008年8月至2013年8月收治的154例重症复杂先心患婴的临床资料,包括早期诊断、术前处理、手术方法、体外循环方案和术后监护等资料.结果 14例死亡,占9.1％ (14/154),4例为术前死亡;手术死亡10例(6.7％,10/150),其中单发畸形3例[完全性大动脉转位(D-TGA)、室间隔缺损(VSD)、肺动脉闭锁(PA)/VSD和主动脉弓中断各1例];复杂畸形7例[右心室发育不良伴/肺动脉狭窄2例,D-TGA/主动脉缩窄(COA)、D-TGA/PS、COA/单心室(SV)、SV/PA/IVS和D-TGA/COA/SV各1例].140例出院后规律随访3个月～5年.8例行二次手术,术后无死亡.结论 早期明确诊断、术前积极改善患儿内环境,及时、合理地手术治疗,个体化的体外循环方案以及严密的术后监护是影响新生儿重症复杂先心手术疗效的重要因素.