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目的探讨婴幼儿左向右分流性先天性心脏病的手术及围术期治疗的规律,分析影响其预后的因素。方法系统回顾1999年3月—2010年3月310例4个月～30个月左向右分流先天性心脏病手术治疗及转归。病种包括:VSD194例,ASD17例,VSD伴ASD23例,VSD伴PDA27例,VSD伴PDA及MS10例,VSD伴ASD及PDA27例,PDA8例,ASD伴TAPCV4例。术前肺动脉收缩压与体动脉收缩压之比>0.75的81例(26.1%)。因难治性肺炎和心衰而急诊手术38例(12.2%)。采用中度低温体外循环下手术。结果住院死亡9例。术后3个月和半年各死亡1例。病死率3.5%(11/310)。年龄小,畸形复杂矫治不完全,术后肺部感染(5例)、持续肺动脉高压(2例)、低心排(2例)、顽固性出血(1例)、营养不良(1例)等是导致死亡的主要因素。结论手术治疗是拯救婴幼儿高危先心病的积极有效手段,提高手术和体外循环技术,有效控制肺部感染是降低死亡率的主要环节。
Objective To investigate the operation and perioperative management of left-to-right shunt congenital heart disease in infants and young infants, and to analyze the factors influencing its prognosis. Methods From March 1999 to March 2010,300 cases of 4 months to 30 months left to right shunt surgical treatment of congenital heart disease and outcome. The disease types included 194 cases of VSD, 17 cases of ASD, 23 cases of VSD with ASD, 27 cases of VSD with PDA, 10 cases of VSD with PDA and MS, 8 cases of VSD with ASD and PDA, 8 cases of PDA and 4 cases of ASD with TAPCV. Preoperative pulmonary artery systolic blood pressure and body systolic blood pressure ratio of 0.75> 81 cases (26.1%). Emergency surgery due to refractory pneumonia and heart failure in 38 cases (12.2%). Moderate hypothermia under cardiopulmonary bypass surgery. Results 9 died in hospital. One case died after 3 months and 6 months after operation. The case fatality rate was 3.5% (11/310). Small age, complex deformity correction, postoperative pulmonary infection (5 cases), persistent pulmonary hypertension (2 cases), low cardiac output (2 cases), intractable bleeding (1 case), malnutrition (1 case) and so on Is the leading cause of death. Conclusion Surgical treatment is an effective and effective way to save infants and young children with high-risk CHD. Improving surgical and cardiopulmonary bypass techniques and effective control of lung infection are the main steps to reduce mortality.