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目的回顾和总结新生儿和小婴儿心脏病手术在上海新华医院、上海儿童医学中心的发展和目前状况,并对新生儿和小婴儿心脏病手术的适应证、手术时机选择、强化围术期生命器官的保护提出方案。方法1973年6月~2004年5月115例新生儿和281例小婴儿在上海第二医科大学新华医院、上海儿童医学中心接受先天性心脏病外科治疗。根据不同的年龄和手术阶段将资料按等级分组对照,N/Ⅰ组:15例,为新生儿第1阶段;N/Ⅱ组:21例,为新生儿第2阶段;N/Ⅲ组:79例,为新生儿第3阶段;I/Ⅰ组:26例,为小婴儿第1阶段;I/Ⅱ组:50例,为小婴儿第2阶段;I/Ⅲ组:205例,为小婴儿第3阶段。新生儿病种分布中大动脉错位(D-TGA)最多,占57例(49.6%),小婴儿病种分布中VSD/PH,或同时伴有房间隔缺损(ASD)和PDA占104例(37.0%),其次为小婴儿D-TGA54例(19.2%)。结果总住院死亡63例(15.9%),新生儿22例,小婴儿41例。N/Ⅰ组、N/Ⅱ组和N/Ⅲ组的病死率分别为33.3%、57.1%和6.3%,新生儿D-TGA和PA/IVS的病死率第3阶段最低。I/Ⅰ组、I/Ⅱ组和I/Ⅲ组的病死率分别为50.0%、22.0%和8.3%。I/Ⅲ组的D-TGA和PA/IVS病死率均明显高于N/Ⅲ组。结论对于复杂和危重先心病应该宣传积极采取早期手术措施,尤其是D-TGA和PA/IVS等疾病新生儿阶段的手术病死率明显低于小婴儿。对于出现心力衰竭和严重缺氧患儿的处理要有急诊手术的观念。通过强化围术期生命器官的保护提高手术生存率。
Objective To review and summarize the development and current status of neonatal and infantile cardiac surgery in Shanghai Xinhua Hospital and Shanghai Children’s Medical Center. The indications of neonatal and infantile cardiac surgery, the timing of operation, and the enhancement of perioperative life Proposed protection of organs. Methods From June 1973 to May 2004, 115 newborns and 281 infants were treated with surgical treatment of congenital heart disease in Xinhua Hospital of Shanghai Second Medical University and Shanghai Children’s Medical Center. According to different age and operation stage, the data were grouped by grade. N / Ⅰ group: 15 cases were neonatal stage 1; N / Ⅱ group: 21 cases, neonatal stage 2; For example, for the third stage of newborn; I / I group: 26 cases for the first stage of infants; I / II group: 50 cases for the second stage of infants; I / III group: 205 cases for young infants Stage 3. There were 57 cases (49.6%) with D-TGA in the distribution of newborns, 104 cases (37.0%) with VSD / PH in small infants and ASD and PDA %), Followed by D-TGA of 54 infants (19.2%). Results The total hospital deaths in 63 cases (15.9%), 22 newborns, 41 small infants. The case fatality rates of N / I, N / II and N / III groups were 33.3%, 57.1% and 6.3%, respectively. The mortality of neonatal D-TGA and PA / IVS was the lowest in the third phase. The fatality rates in I / I group, I / II group and I / III group were 50.0%, 22.0% and 8.3% respectively. The mortality rates of D-TGA and PA / IVS in group I / III were significantly higher than those in group N / III. Conclusions Positive and early operative measures should be advocated in patients with complex and critically-congenital heart disease. In particular, the mortality rate during the neonatal period such as D-TGA and PA / IVS is significantly lower than that of young infants. For the treatment of children with heart failure and severe hypoxia have the concept of emergency surgery. Survival rate can be improved by strengthening perioperative protection of vital organs.