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目的 总结小儿危重先天性心脏病急诊手术的经验 ,探讨急诊手术的必要性和降低围手术期死亡和并发症的措施。方法 回顾分析 1998年 1月～ 2 0 0 1年 10月急诊手术治疗小儿危重先天性心脏病 2 5 0例。男 176例 ,女 74例 ;术前反复呼吸道感染、心力衰竭或呼吸衰竭者 12 1例 ,严重低氧血症者 12 0例 ,其他危重患儿共 9例 ;不用体外循环手术 2 2例 (36例次 ) ,常温平行体外循环2 0例 ,中度低温体外循环 16 5例 ,深低温低流量或停循环 43例。根治手术 2 33例 ,姑息手术 17例。结果 全组术中死亡 12例 ,早期死亡 18例 ,总病死率为 12 .0 % (30 / 2 5 0 )。存活的 2 2 0例中术后主要并发症包括残余病变、重要脏器功能不全、感染和呼吸机依赖等。结论 急诊手术是挽救小儿危重先心病的有效手段 ,准确诊断、快速转运以及正确、合理的体外循环和手术方法降低手术对重要脏器的损害是提高手术成功率的关键
Objective To summarize the experience of emergency surgery in critically ill children with congenital heart disease and to discuss the necessity of emergency surgery and measures to reduce perioperative mortality and complications. Methods A retrospective analysis of emergency surgery in January 1998 ~ October 2001 emergency treatment of children with congenital heart disease 250 cases. 176 males and 74 females; 121 cases of recurrent respiratory tract infection, heart failure or respiratory failure, 120 cases of severe hypoxemia and 9 cases of other critically ill children before surgery; no need for extracorporeal circulation in 22 cases 36 cases), 20 cases of normal cardiopulmonary bypass, 165 cases of moderate hypothermic cardiopulmonary bypass, 43 cases of deep hypothermia, low flow rate or circulatory arrest. There were 233 cases of radical surgery and 17 cases of palliative surgery. Results The whole group died of intraoperative death in 12 cases and early death in 18 cases, with a total case fatality rate of 12.0% (30/250). Survival of 220 cases of major complications include residual disease, vital organ insufficiency, infection and ventilator dependence. Conclusions Emergency surgery is an effective way to save children with critical congenital heart disease. Accurate diagnosis, rapid transit, correct and reasonable cardiopulmonary bypass and surgical methods to reduce the damage to vital organs during operation are the keys to improve the success rate of operation