中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

203 例低出生体重新生儿心脏手术的早期疗效及死亡原因分析

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目的 分析 203 例低出生体重(<2 500 g)新生儿行心脏外科手术的早期疗效,并对住院期间死亡的患者进行原因分析。 方法 回顾性分析 2003 年 6 月至 2017 年 6 月广东省人民医院心脏病研究所 203 例行开胸心脏手术的低出生体重新生儿的临床资料,其中男 124 例、女 79 例,早产儿 151 例,平均出生体重(1 719±515)g,平均手术时年龄(32.7±20.2)d,平均手术时体重(1 994±486)g。对住院期间死亡的患者(包括家长放弃治疗后死亡的病例)进行原因分析。 结果 术前 103 例患者合并肺炎,98 例患者需要术前机械通气支持呼吸,26 例患者因病情需要急诊手术。所有患者均在气管插管全身麻醉下行先天性心脏病矫治术,其中行非体外循环手术 107 例,体外循环手术 96 例,平均体外循环时间(96.5±71.7)min,平均主动脉阻断时间(51.8±45.5)min。术后平均机械通气时间(9.1±21.5)d,术后平均住院时间(26.7±19.3)d,术后主要的并发症包括肺炎、贫血、肺不张、败血症、胸腔内出血、膈肌麻痹、心功能不全等。住院期间共死亡 29 例,总体死亡率为 14.3%,其中术中死亡 4 例,术后早期(72 h 内)死亡 14 例,放弃治疗 2 例。住院期间患者心脏术后死亡的主要原因依次是低心排血量综合征、重症感染、弥漫性血管内凝血障碍、急性肾衰竭以及肺动脉高压危象等。 结论 总的来说,对低出生体重新生儿早期施行心脏外科手术是安全而有效的。手术的难易程度是影响患者预后的关键,良好的围手术期管理能够降低患者围手术期死亡和并发症发生的风险。

Objective To analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization. Methods From June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed. Results Totally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis. Conclusion Overall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.

关键词: 新生儿; 低出生体重; 先天性心脏病手术; 早期疗效; 死亡原因

Key words: Neonates; low birth weight; congenital heart surgery; early outcome; death cause

引用本文: 鲁超, 郁丽娜, 韦锦峰, 梁杰贤, 庄建, 王晟. 203 例低出生体重新生儿心脏手术的早期疗效及死亡原因分析. 中国胸心血管外科临床杂志, 2018, 25(11): 971-976. doi: 10.7507/1007-4848.201712039 复制

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