摘要
目的 总结新生儿主动脉缩窄合并室间隔缺损的一期手术疗效.方法 回顾性分析 2010年1月1日至2019年12月31日在广东省人民医院44例行主动脉缩窄合并室间隔缺损的一期治疗新生儿的临床资料.其中男30例,女14例,日龄为(19.7±6.5)d,体质量为(3.2±0.5)kg.结果 术后院内死亡2例(4.5%).住院期间其他并发症总发生率为 40.5%,包括隔肌麻痹 2 例(4.5%),声带麻痹 4例(9.1%),伤口感染 4例(9.1%),心律失常3例(6.8%),肺部感染10例(22.7%),重度低心排血量综合征需要体外膜肺氧合(ECMO)辅助2例(4.5%),急性肾功能不全需要腹膜透析1例(2.3%).Logistic多因素逐步回归分析示体外循环时间(P=0.018)是术后住院死亡的危险因素.线性回归结果分析示术前重症监护病房(intensive care unit,ICU)停留时间(P=0.000)与住院时间相关.随访中再次手术干预率为7.1%,其中1例患儿出现吻合口再次狭窄,行手术矫治术.2例患儿出现左心室流出道梗阻,均行外科矫治.电话随访中发现1例患儿主动脉瓣下隔膜,速度为4.2 m/s,电话通知尽快入院治疗.1例患儿术前已诊断缺血缺氧脑病、重症肺炎,术后顺利出院,随访中为脑瘫,智力发育迟缓.随访中未发现原发性高血压患儿.结论 新生儿主动脉缩窄合并室间隔缺损的一期手术病死率已经极大降低,但是住院期间并发症发生率仍较高;术前ICU停留时间与延迟恢复显著相关;体外循环时间是术后住院死亡的危险因素;中远期病死率较低,应密切关注主要并发症——吻合口再次狭窄、左心室流出道梗阻对患儿生存的影响.
Abstract
Objectives To review the effect of the one-stage repair on coarctation of the aorta(CoA)and ventricular septal defect in neonates.Methods The clinical data about the neonates who had undergone CoA and ventricular septal defect repair between January 2010 and December 2019 were reviewed in Guangdong Provincial People's Hospital.These neonates included 30 males and 14 females.They were(19.7±6.5)d old and their weight was(3.2±0.5)kg.Results There were 2 in-hospital deaths(mortality at 4.5%).During hospitalization,the overall incidence of other complications was 40.5%,including 2 cases of diaphragmatic paralysis(4.5%),4 cases of vocal cord paralysis(9.1%),4 cases of wound infection(9.1%),3 cases of arrhythmia(6.8%),10 cases of pulmonary infection(22.7%),2 cases of severe low cardiac output requiring extracorporeal membrane oxygenation(ECMO)assistance(4.5%),and 1 case of acute renal insufficiency requiring peritoneal dialysis(2.3%).The multivariable regression analysis showed that cardio-pulmonary was an independent risk factor for early death in hospitalization.The linear regression analysis showed that pre-operative intensive care unit(ICU)duration was directly associated with the total in-hospital duration.During the follow-up,there was no death and 3 neonates(7.1%)had undergone reoperations,including 1 neonates underwent surgical repair of recurrent aortic arch obstruction and 2 neonates underwent reoperation because of their left ventricular out-flow tract obstruction(LVOTO).During telephone follow-up,one neonate was found to have a subaortic valve dia-phragm with a velocity of 4.2 m/s.The neonate had been notified by phone to be admitted for treatment as soon as pos-sible.One neonate was diagnosed with ischemic hypoxic encephalopathy and severe pneumonia before surgery,and was discharged smoothly after surgery.During follow-up,the neonate was diagnosed with cerebral palsy and delayed intel-lectual development.No cases of hypertension were found.Conclusions The mortality of the one-stage repair on CoA and ventricular septal defect in neonates has been greatly reduced,but the incidence of complications during hospitaliza-tion is still high.The cardiopulmonary is an independent risk factor of early death.Preoperative duration of ICU is directly associated with the delay recovery.The total mortality is low,but the main postoperative complication such as LVOTO and recoarctation in the follow-up should remain concern.
维普
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