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目的回顾性总结和分析595例3岁以下婴幼儿先天性心脏病的诊断、手术时机、手术方法、围术期处理等,以进一步提高此类患者的手术成功率和远期效果。方法 2011年1月-2012年11月,手术治疗3岁以下婴幼儿先心病患者595例,其中男315例,女280例,体重3.2~14kg。全组患者均一期手术。体外循环采用1:4冷含血心肌保护液保护心肌,转流中控制血细胞压积(HCT)0.20~0.25。体外循环停机后采用改良超滤(MUF),手术结束时HCT0.35~0.40。结果全组术后均入ICU治疗,呼吸机辅助3~136(10.3±6.6)h。术后出现并发症52例,发生率8.74%。手术死亡14例,死亡率2.35%。随访3个月至1年11个月,院外死亡3例,失访63例,其余患儿生长发育改善,体重增加。结论掌握适当的手术指征、手术方法、手术时机,建立专业的团队,婴幼儿先天性心脏病手术效果良好。
Objective To retrospectively summarize and analyze the diagnosis of 595 infants with congenital heart disease under 3 years old, timing of surgery, surgical methods, perioperative management and so on, so as to further improve the success rate and long-term success of such patients. Methods From January 2011 to November 2012, 595 patients with congenital heart disease under 3 years old were surgically treated, including 315 males and 280 females, weighing 3.2 to 14 kg. All patients were stage operation. Cardiopulmonary bypass with 1: 4 cold blood cardioprotective fluid to protect the myocardium, controlling the conversion of hematocrit (HCT) 0.20 ~ 0.25. After modified off-pump using modified ultrafiltration (MUF), HCT 0.35 ~ 0.40 at the end of surgery. Results All the patients were admitted to ICU after operation, ventilator assisted 3 ~ 136 (10.3 ± 6.6) h. Postoperative complications occurred in 52 cases, the incidence rate of 8.74%. 14 cases died of surgery, the mortality rate was 2.35%. During 3 months to 1 year and 11 months follow-up, 3 were hospital-based deaths and 63 were lost to follow-up. The rest of the children showed improved growth and weight gain. Conclusion Appropriate surgical indications, surgical methods, timing of surgery, the establishment of a professional team, infants congenital heart disease surgery good effect.