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目的探讨新生儿主动脉弓中断(IAA)合并心内畸形的一期手术矫治效果。方法回顾性分析2003年5月至2014年9月我院采用经胸骨正中切口下一期手术矫治IAA合并心内畸形新生儿21例的临床资料,其中男18例、女3例,年龄6~26(15.9±5.8)d。A型14例,B型7例。手术均采用胸骨正中切口,端侧吻合降主动脉及主动脉弓,同期矫治合并心内畸形。结果机械通气时间14~809(237.8±179.7)h,体外循环时间92~174(132.6±27.1)min,主动脉阻断时间48~118(70.9±18.8)min,深低温停循环时间5~60(28.8±15.5)min,住院时间4~52(28.0±12.1)d。住院期间死亡3例(14.3%),分别因手术后败血症、肺动脉高压危象、心脏骤停而死亡。18例新生儿生存,随访3个月至11年,超声检查示患儿术后心功能良好。结论新生儿IAA合并心内畸形采用经胸骨正中切口一期手术矫治减少了手术次数,提高了患儿生活质量,手术效果良好。
Objective To investigate the effect of primary correction of neonatal aortic arch dislocation (IAA) with intracardiac deformity. Methods The clinical data of 21 neonates with IAA with intra-heart deformity underwent trans-sternal mid-incision in our hospital from May 2003 to September 2014 were retrospectively analyzed. There were 18 males and 3 females, aged 6 ~ 26 (15.9 ± 5.8) d. A type in 14 cases, B type in 7 cases. Surgical use of the median incision in the sternum, end anastomosis of the descending aorta and aortic arch, correction of heart deformity over the same period. Results The time of mechanical ventilation was 14 ~ 809 (237.8 ± 179.7) h, the duration of cardiopulmonary bypass was 92 ~ 174 (132.6 ± 27.1) min, the time of aorta block was 48 ~ 118 (70.9 ± 18.8) min and the duration of hypothermic circulatory arrest was 5 ~ 60 (28.8 ± 15.5) min and hospital stay of 4 ~ 52 (28.0 ± 12.1) days. 3 died during hospitalization (14.3%), respectively, due to postoperative sepsis, pulmonary hypertension crisis, cardiac arrest and death. 18 cases of newborn survival, followed up for 3 months to 11 years, ultrasound showed that children with good cardiac function after surgery. Conclusion Neonatal IAA with intracardiac deformity using a median sternotomy surgical treatment reduced the number of operations, improve the quality of life of children with good surgical results.