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目的总结术前呼吸机支持的先天性心脏病(先心病)的外科治疗经验。方法回顾性分析2011年9月-2012年4月16例术前呼吸机支持的先心病患儿资料。其中男10例,女6例;年龄21 d～7个月,其中10例为2个月以下。术前6例因严重低氧血症、10例因肺炎导致呼吸衰竭上呼吸机治疗。术前呼吸机支持时间为1～20 d,16例均行手术治疗,根据病种不同,选择不同的手术及体外循环方式,14例选择解剖纠治,2例选择分期手术。结果主动脉阻断时间为(34.34±30.24)(24～93)min,体外循环时间为(54.28±60.43)(34～196)min,术后呼吸机支持时间为(98.21±100.36)(40～391)h,ICU滞留时间为(7.25±12.94)(4～19)d。术中死亡1例,术后死亡2例,3例均死于肺出血,其余痊愈出院。术后2例由于体外循环后血流动力学不稳定而延迟关胸、3例出现低心排出量综合征、3例需腹膜透析、1例乳縻胸术后1周行胸导管结扎后治愈。8例痰培养为阳性,其中5例术前痰培养已为阳性。无一例发生伤口或纵隔感染。结论术前呼吸机支持先心病手术干预风险高,并发症多,术后恢复慢。应尽量在未出现危重症状前手术治疗。
Objective To summarize the surgical experience of preoperative ventilator-supported congenital heart disease (CHD). Methods The data of 16 patients with congenital heart disease supported by preoperative ventilator between September 2011 and April 2012 were retrospectively analyzed. Including 10 males and 6 females; aged 21 d ~ 7 months, of which 10 were less than 2 months. Preoperative 6 cases due to severe hypoxemia, 10 cases of respiratory failure caused by pneumonia on ventilator therapy. Preoperative ventilator support time was 1 ~ 20 d, 16 patients underwent surgical treatment, depending on the disease, choose a different surgical and cardiopulmonary bypass, 14 cases of anatomical treatment, 2 cases of staging surgery. Results The time of aortic block was (34.34 ± 30.24) min (24-93 min) and the duration of cardiopulmonary bypass was (54.28 ± 60.43) (34- 196 min). The duration of ventilator support after operation was (98.21 ± 100.36) 391) h, ICU residence time was (7.25 ± 12.94) (4 ~ 19) d. 1 patient died during operation, 2 patients died after operation, 3 patients died of pulmonary hemorrhage, and the rest were cured. Postoperative 2 patients had delayed chest closure due to hemodynamic instability after cardiopulmonary bypass, 3 patients had low cardiac output syndrome, 3 required peritoneal dialysis, and 1 patient received postoperative thoracotomy for 1 week . 8 cases of sputum culture was positive, of which 5 cases of preoperative sputum culture has been positive. No case of wound or mediastinal infection. Conclusion Preoperative ventilator support for surgery risk of congenital heart disease, complications, and postoperative recovery is slow. As far as possible in the absence of critical symptoms before surgery.