新生儿危重先天性心脏病的手术治疗结果及围术期处理分析

摘要

目的 总结本院新生儿危重先天性心脏病的手术经验及围术期处理体会,探讨新生儿危重先天性心脏病的诊治方法. 方法 回顾性分析2014年1月至2017年9月本院心胸外科收治的62例新生儿危重先天性心脏病患儿的临床资料,其中男47例,女15例.病种构成:主动脉弓疾病22例(主动脉缩窄并室间隔缺损20例,主动脉弓中断2例),完全性肺静脉异位引流18例,大动脉转位10例,室间隔缺损并肺动脉高压8例,肺动脉狭窄3例,主动脉狭窄合并肺动脉狭窄1例,除1例肺动脉瓣狭窄采用杂交手术以外,其余61例均采用体外循环下根治手术治疗. 结果 62例中,痊愈出院57例,死亡6例,病死率为9.7%.手术后采用延迟关胸26例,术后出现心律失常8例,膈肌麻痹1例,坏死性小肠结肠炎1例,少尿6例. 结论 新生儿危重先天性心脏病于早期采取积极有效的干预可获得良好的效果.尽早诊断,合理把握手术时机,不断提高手术技术、体外循环技术及围手术期管理水平是改善新生儿危重先天性心脏病预后的关键,建立新生儿先天性心脏病的医院间多学科协同网络救治是今后发展的方向.%Objective To summarize the surgical experiences and perioperative managements of neo-natal critical congenital heart disease(CCHD).Methods From January 2014 to September 2017,clinical da-ta were reviewed for 62 CCHD cases including 47 boys and 15 girls.The etiologies included aortic arch disease (n=22)(including 20 aortic coarctaions with ventricular septal defect and 2 interruptions),total anomalous pulmonary venous drainage(n=18),transposition of great arteries(n=10),ventricular septal defect & pul-monary arterial hypertension(n=8),pulmonary artery stenosis(n=3)and aortic stenosis with pulmonary ar-tery stenosis(n=1).One case of pulmonary artery stenosis underwent hybrid procedure while the remainder had radical cardiac surgery by cardiopulmonary bypass.Results Among them,57 cases were discharged while 5 cases died with a mortality rate of 9.7%.And 26 cases were treated by delayed sternal closures.Six cases re-ceived peritoneal dialysis.There were arrhythmia(n=8),diaphragmatic palsy(n=1)and necrotizing entero-colitis(n=1).Conclusion Early intervention for neonatal CCHD may achieve excellent outcomes.Early di-agnosis,optimal timing of surgery,continuous improvements of surgical techniques,cardiopulmonary bypass technology and perioperative managements are essential for improving the prognosis of neonatal CCHD.Establis-hing a multidisciplinary collaborative network is a future trend.