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目的:总结低出生体重儿(LBWI)行体外循环心脏手术的麻醉处理体会,对围术期管理进行探讨。方法:回顾分析17例低出生体重先心病手术患儿,出生体重1225～2500g,平均(2109.1±399.29)g;孕30.3～42.2周,平均(36.5±2.81)周。手术时日龄为8～79d,平均(28.4±18.39)d,手术日体重1628～3205g,平均(2369.7±413.50)g。其中早产儿10例。所有患儿均在全身麻醉体外循环完成心内畸形矫治手术。结果:本组病例无术中死亡。体外循环时间30～160min,平均(90.6±42.80)min,主动脉阻断时间14～125min,平均(53.5±28.55)min。术后持续机械通气,并用血管活性药物维持血流动力学稳定。11例延迟关胸。术后早期死亡4例,病死率23.5%。结论:LBWI先心病应早期手术治疗,良好的麻醉管理有助于降低围术期的病死率和并发症发生率,并提高术后的生存率。
Objective: To summarize the experiences of anesthesia in cardiopulmonary bypass with low birth weight infants (LBWI) and discuss the management of perioperative period. Methods: A retrospective analysis of 17 cases of children with low birth weight congenital heart disease surgery, birth weight 1225 ~ 2500g, an average of (2109.1 ± 399.29) g; pregnant 30.3 ~ 42.2 weeks, an average of (36.5 ± 2.81) weeks. The age of operation was from 8 to 79 days, with an average of (28.4 ± 18.39) days and weight of 1628 to 3205g on the operation day (mean, 2369.7 ± 413.50) g. 10 cases of preterm children. All children underwent cardiopulmonary deformity surgery under general anesthesia cardiopulmonary bypass. Results: There were no intraoperative deaths in this group of patients. The time of cardiopulmonary bypass was 30 ~ 160min, with an average of (90.6 ± 42.80) min and aortic blockade of 14 ~ 125min (mean, 53.5 ± 28.55) min. Postoperative continuous mechanical ventilation, and use of vasoactive drugs to maintain hemodynamic stability. Eleven patients with delayed chest closure. In the early postoperative death in 4 cases, the fatality rate was 23.5%. Conclusion: LBWI congenital heart disease should be treated early, good anesthesia management can help to reduce perioperative mortality and complications, and improve postoperative survival rate.