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目的探讨婴幼儿危重先天性心脏病急诊手术的适应证、手术技术和围术期处理。方法2000年10月至2006年10月为128例危重先天性心脏病婴幼儿施行急诊或亚急诊手术;年龄7d～36个月,平均(4.8±1.6)个月;体重2.5～12.8kg,平均(5.8±2.4)kg;术前反复呼吸道感染、心力衰竭及呼吸衰竭109例,严重低氧血症19例;根治手术123例,姑息手术5例。结果全组住院死亡12例。9例死于术后低心排血量综合征(2例为完全型大动脉转位,行大动脉调转术;2例为法洛四联症及2例室隔完整型肺动脉闭锁;1例完全性肺静脉异位引流及2例室间隔缺损合并重度肺高压)。3例室间隔缺损合并重度肺高压,均为术前反复发生肺炎、心力衰竭,术后脱离呼吸机困难,死于呼吸衰竭和肺部感染。其余患者均治愈。结论婴幼儿危重先天性心脏病急诊、亚急诊外科治疗是可行的,可以挽救大部分患者的生命,正确、适时修复心脏畸形,恢复合理的血流动力学是提高手术成功率的关键。
Objective To investigate the indications, surgical techniques and perioperative management of emergency surgery for critically ill congenital heart disease in infants and young children. Methods From October 2000 to October 2006, 128 cases of critically congenital heart disease infants underwent emergency or sub-emergency surgery. The patients were 7 days to 36 months with an average of (4.8 ± 1.6) months and 2.5 to 12.8 kg, mean (5.8 ± 2.4) kg, 109 cases of recurrent respiratory tract infection, heart failure and respiratory failure, 19 cases of severe hypoxemia, 123 radical surgery and 5 palliative surgery. Results All the patients died in hospital in 12 cases. 9 cases died of postoperative low cardiac output syndrome (2 cases of complete aortic transposition, aortic transfer surgery; 2 cases of tetralogy of Fallot and 2 cases of complete pulmonary atresia; 1 case of complete Anomalous pulmonary venous drainage and 2 cases of ventricular septal defect with severe pulmonary hypertension. 3 cases of ventricular septal defect complicated with severe pulmonary hypertension, both preoperative recurrence of pneumonia, heart failure, difficulty breathing out after surgery, died of respiratory failure and lung infection. The remaining patients were cured. Conclusion The critical emergency treatment of critical congenital heart disease in infants and young children, sub-emergency surgical treatment is feasible, can save the lives of most patients, correct and timely repair of cardiac malformations, to restore reasonable hemodynamics is the key to improving the success rate of surgery.