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目的:回顾性总结经先天性心脏病(先心病)三级预防网络“绿色通道”救治新生儿室间隔完整型完全性大动脉转位的临床经验。方法:收集2010年1月至2012年12月,经“绿色通道”转诊至我院的8例室间隔完整型完全性大动脉转位新生儿临床资料,总结分析临床疗效及转归。结果:8例患儿,男性5例,女性3例。入院年龄2～12 d,平均(5.9±2.7)d,手术日龄2～14 d,平均(8.1±2.6)d,体质量2.3～7.5 kg,平均(3.5±0.6)kg。术前严重酸中毒,呼吸衰竭1例行气管插管治疗,1例合并肾衰竭,所有患儿均直接行(arterial switch operation,ASO),手术成功率100%。术后延迟关胸5例,围术期死亡1例(12.5%),死因为多脏器功能衰竭。术后3～6个月,2次随访。手术治愈的7例患儿生长发育良好,左心室心功能正常范围,平均左心室射血分数(LVEF)分别为(67.0±2.8)%和(70.3±4.0)%,左心室心肌质量指数也显著增高。结论:完全性大动脉转位患儿应尽早诊断,提高产前诊断率加强术前内科治疗,纠正代谢紊乱,维护心功能,把握手术时机,尽快根治是成功的关键。通过先心病三级预防框架实施“绿色通道”救治室间隔完整型完全性大动脉转位,对提高危重患儿存活率,减少新生儿死亡有重要意义。
OBJECTIVE: To retrospectively summarize the clinical experiences of transposition of intact intact aorta of neonates with interventricular septum through congenital heart disease (CHD) tertiary prevention network “green channel”. Methods: From January 2010 to December 2012, 8 cases of complete transposition of aortic intact aorta were referred to our hospital via “Green Channel”. Clinical data and clinical outcomes were collected and analyzed. Results: 8 cases of children, 5 males and 3 females. The average hospitalization was from 2 to 12 days, with an average of (5.9 ± 2.7) days. The operative age ranged from 2 to 14 days (mean, 8.1 ± 2.6 days) and body weight ranged from 2.3 to 7.5 kg (average, 3.5 ± 0.6) kg. Severe acidosis and respiratory failure were preoperatively treated with endotracheal intubation (1 case) and renal failure (1 case). All children underwent routine arterial switch operation (ASO). The success rate was 100%. Postoperative delayed closure of the chest in 5 cases, perioperative death in 1 case (12.5%), the cause of death was multiple organ failure. After 3 to 6 months, 2 follow-up. Seven cases of surgery cured showed good growth and normal heart function, left ventricular ejection fraction (LVEF) were (67.0 ± 2.8)% and (70.3 ± 4.0)% respectively, and left ventricular mass index Increase. Conclusion: The diagnosis of complete aortic transposition in children should be diagnosed as soon as possible to improve the prenatal diagnosis rate to strengthen preoperative medical treatment, to correct metabolic disorders, maintain heart function, grasp the timing of operation and cure as soon as possible is the key to success. Through the tertiary prevention framework of congenital heart disease implementation of the “green channel” treatment of complete and complete transthoracic transposition of the interventricular septum, to improve the survival rate of critically ill children, reduce neonatal mortality is of great significance.