CAJ | 학술논문

目的：总结53例低出生体质量新生儿及早产儿先天性心脏病外科手术的麻醉管理，并探讨其围术期的危险因素。方法2003年6月~2013年7月共在非体外循环下完成53例低出生体质量儿先天性心脏病手术，其中49例为早产儿。本组病例孕周26~40周（30.96±3.09）周，出生体质量640~2460（1429.90±455.08）g。手术时日龄4~87（32.81±20.76）d；手术时体质量650~2460（1750.20±481.59）g。所有患儿均在全身麻醉下完成先心病非体外循环矫治手术。根据血气分析结果对呼吸参数、患儿体内酸碱平衡及电解质进行调整，应用血管活性药物控制血压并维持术后血流动力学稳定，术后持续机械通气，置暖箱保温。结果本组病例中有47例为PDA结扎术，其中有1例未行手术即发生心跳骤停，未能心肺复苏；1例由于术前诊断有误，术中经食管超声诊断后修正诊断为主动脉瓣及升主动脉重度发育不良，不能行PDA结扎术，放弃治疗；2例COA矫治术，其中1例于手术中发生心跳骤停，术中死亡；2例为PDA结扎同期COA矫治术；其余2例为紫绀型先天性心脏病，分别行A-P分流术+Broch术和B-T分流术。本组病例术中死亡2例，死亡率3.77%，术后早期死亡（72 h内）1例，总死亡率5.66%。结论低出生体质量儿可实施早期非体外循环下先心病手术；良好的麻醉管理有助于降低围术期的死亡率和并发症发生率，并提高术后生存率。
목적：총결53례저출생체질량신생인급조산인선천성심장병외과수술적마취관리，병탐토기위술기적위험인소。방법2003년6월~2013년7월공재비체외순배하완성53례저출생체질량인선천성심장병수술，기중49례위조산인。본조병례잉주26~40주（30.96±3.09）주，출생체질량640~2460（1429.90±455.08）g。수술시일령4~87（32.81±20.76）d；수술시체질량650~2460（1750.20±481.59）g。소유환인균재전신마취하완성선심병비체외순배교치수술。근거혈기분석결과대호흡삼수、환인체내산감평형급전해질진행조정，응용혈관활성약물공제혈압병유지술후혈류동역학은정，술후지속궤계통기，치난상보온。결과본조병례중유47례위PDA결찰술，기중유1례미행수술즉발생심도취정，미능심폐복소；1례유우술전진단유오，술중경식관초성진단후수정진단위주동맥판급승주동맥중도발육불량，불능행PDA결찰술，방기치료；2례COA교치술，기중1례우수술중발생심도취정，술중사망；2례위PDA결찰동기COA교치술；기여2례위자감형선천성심장병，분별행A-P분류술+Broch술화B-T분류술。본조병례술중사망2례，사망솔3.77%，술후조기사망（72 h내）1례，총사망솔5.66%。결론저출생체질량인가실시조기비체외순배하선심병수술；량호적마취관리유조우강저위술기적사망솔화병발증발생솔，병제고술후생존솔。
Objective To summarize anesthetic management of low birth weight infants undergoing surgical intervention of congenital heart disease without cardiopulmonary bypass. Methods Fifty-three low birth weight infants (including 49 premature infants) with congenital heart disease underwent surgical treatment without cardiopulmonary bypass during the period from June, 2003 to July, 2013. The mean gestational age of the infants was 30.96±3.09 weeks (26-40 weeks) with a mean age on the operation day of 32.81 ± 20.76 days (4-87 days), birth weight of 1429.90 ± 455.08 g (640-2460 g), and weight on the operation day of 1750.20±481.59 g (650-2460 g). All the infants underwent cardiac operations without cardiopulmonary bypass under general anesthesia. The respiratory parameters and acid-base and electrolyte balance were adjusted according to blood gas analysis. The inotropic drug was used to maintain the hemodynamic stability. Results Forty-seven of the infants received patent ductus arteriosus (PDA) ligation. Of these infants, 1 had cardiac arrest before the operation with failed cardiopulmonary resuscitation, and in another case, PDA ligation was aborted due to severe hypoplasia of the aortic valve and ascending aorta found intraoperatively by transesophageal echocardiography. Two infants underwent coarctation of the aorta (CoA), and 1 of them died during the operation due to cardiac arrest. The total mortality of these infants was 3.77%and the early postoperative mortality (<72 h) was 5.66%. Conclusion Non-cardiopulmonary bypass surgery can be performed in low birth weight infants in early stage, and effective anesthetic management can reduce the perioperative mortality and improve the postoperative survival rate.