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目的总结低体质量(≤5 kg)心脏畸形患儿的外科治疗经验。方法回顾我院从2005年4月~2006年11月连续收治116例体质量小于5 kg的心脏畸形患儿的临床资料,分析低体质量心脏畸形患儿的手术时机、风险因素及围手术期处理经验。结果116例患儿平均年龄21 d~10月(79±50)d,体质量2.4~5(3.6±1.1)kg。106例(91.4%)患儿在中低温体外循环下进行手术矫治,10例(8.6%)患儿在深低温停循环和选择性脑灌注下进行手术矫治。105例(90.5%)患儿痊愈出院,3例患儿明显好转,死亡8例(6.9%)。2例死于心功能衰竭,2例死于败血症,2例死于肾功能衰竭,1例死于多脏器功能衰竭,1例死于脑出血。术后早期并发症有:呼吸机延期辅助呼吸26例,肺部感染5例,伤口感染3例,膈肌麻痹2例,低血糖2例。呼吸机辅助平均时间8 h~21 d(19.2±6.7)h,ICU时间2~35(4.8±1.1)d。结论低体质量心脏畸形患儿手术矫治近期疗效满意,深低温停循环时间是影响手术死亡率的重要因素,体外循环时间与术后并发症的发生密切相关,外科矫治采用一期根治或是姑息手术应综合考虑近期与远期疗效,手术后治疗强调营养支持和呼吸道管理。
Objective To summarize the experience of surgical treatment of children with heart defects of low body mass (≤5 kg). Methods The clinical data of 116 children with cardiac malformation who were less than 5 kg in weight from April 2005 to November 2006 were retrospectively analyzed. The operative timing, risk factors and perioperative period were analyzed in children with low birth weight heart malformation Experience. Results The average age of 116 children was 21 d ~ 79 months (79 ± 50 days), and the body weight was 2.4 ~ 5 (3.6 ± 1.1) kg. One hundred and six children (91.4%) underwent surgery under hypothermia and cardiopulmonary bypass. Ten children (8.6%) underwent surgery under deep hypothermic circulatory arrest and selective cerebral perfusion. All 105 cases (90.5%) were cured and discharged, and 3 cases improved obviously, with 8 deaths (6.9%). 2 died of heart failure, 2 died of sepsis, 2 died of renal failure, 1 died of multiple organ failure and 1 died of cerebral hemorrhage. Early postoperative complications were ventilator delayed assisted breathing in 26 cases, lung infection in 5 cases, wound infection in 3 cases, diaphragm paralysis in 2 cases and hypoglycemia in 2 cases. Ventilator assisted averaging time of 8 h ~ 21 d (19.2 ± 6.7) h, ICU time of 2 ~ 35 (4.8 ± 1.1) d. Conclusion The surgical treatment of children with heart failure of low body mass has satisfactory short-term curative effect. Deep hypothermic circulatory arrest is an important factor affecting the mortality of surgery. The time of extracorporeal circulation is closely related to the occurrence of postoperative complications. Surgery should be combined with immediate and long-term efficacy, postoperative treatment emphasizes nutritional support and respiratory management.