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新生儿危重复杂先天性心脏病外科干预效果分析

Techniques and experience which improve the surgical outcomes of critical and complex congenital heart disease in neonates

摘要:

目的 探讨新生儿危重先天性心脏病外科治疗的效果和经验.方法 回顾性分析2009年1月至2017年12月在复旦大学附属儿科医院心血管中心接受外科治疗的危重复杂先天性心脏病并接受外科干预的841例新生儿患者的临床资料.男性557例,女性284例.年龄为(11±9)d[范围:0~28d;M(QR):8(17)d],早产儿占6.5%(55/841),体重为(3.26±0.57) kg[范围:1.9~5.0 kg;M(QR):3.3(0.7)kg].合并其他畸形189例.术前机械通气比例为13.6%(114/841),严重酸中毒136例.均在全身麻醉下接受外科干预,包括传统心脏外科手术、复合手术治疗.术后对症治疗.结果 全组患者急诊手术35例,姑息手术100例,根治手术633例,复合手术108例,院内病死率为4.0%(34/841).存活患者机械通气时间为1.5~1 130.0 h[M(QR):94(116) h],再插管率为3.3%(27/807).存活患者心脏ICU停留时间为1~195 d[M(QR):14(15)d].结论 早期诊断和筛查的开展及绿色转运通道的建立,围手术期多学科支持、复合技术的发展和进步,共同改善了新生儿危重复杂先天性心脏病外科干预的效果.

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abstracts:

Objective To discuss the experience of early surgical intervention to critical and complex congenital heart diseases (CHD) in neonates.Methods A retrospective study of clinical records of patients with congenital heart diseases underwent surgical intervention in one single pediatric cardiac center was performed.From January 2009 to December 2017,841 critical and complex CHD neonates were identified at Department of Cardiovascular Surgery,Children's Hospital of Fudan University,of which 6.5% were premature.There were 557 male and 284 female patients.The age was (11±9) days,ranging from 0 to 28 days,M(QR):8 (17) days.The weight was (3.26±0.57) kg,ranging from 1.9 to 5.0 kg,M(QR):3.3(0.7) kg.There were 189 patients associated with other malformation besides CHD.Before surgery,13.6% (114/841) patients were on ventilation,and severe acidosis was addressed in 136 patients.All patients underwent surgical interventions,including surgical procedures and hybrid procedures.Results Emergency surgeries were performed in 35 patients.One hundred patients had palliative procedures,other 633 patients had complete repair,while the rest 108 patients underwent hybrid procedures.The in-hospital mortality was 4.0% (34/841).The ventilation time was 1.5 to 1 130.0 hours,M(QR):94 (116) hours,with the rate of reintubation 3.3% (27/807).The ICU stay time was 1 to 195 days,M(QR):14 (15) days.Conclusion The improvement on early screening and diagnosing,referral system,multidisciplinary cooperation and hybrid invention skills together contributed to better outcomes of critical and complex congenital heart diseases in neonates.

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