中文摘要：

目的总结60例低出生体重新生儿（low birth weight infant，LBWI）及早产儿先天性心脏病外科手术的术后监护治疗经验。方法2003年5月至2011年10月共为60例2500g以下LBWI先天性心脏病新生儿进行外科手术治疗。本组病例孕周26-42周，平均（33．50±4．07）周，出生体重640±2500g，平均（1729．3±522．45）g，其中47例为早产儿。手术时日龄4～55d，平均（24．88±12．49）d；手术时体重650～2712g，平均体重（1953．2±463．57）g。术前所有患儿均在NICU接受治疗。患儿均在全麻下接受先心病矫治手术，其中非体外循环组29例，体外循环组31例（不停跳3例，深低温停循环4例）。全组患儿术后进入心外小儿ICU进行监护治疗。结果全组患儿住院期间死亡13例，总病死率为21．7%。其中术中死亡4例，手术病死率6．7%；术后早期死亡（72h内）6例，占总例数10．0％；术后家属放弃治疗3例，占总例数5．0％。体外循环时间35-326min，平均（121．0±74．6）min；主动脉阻断时间27～173min，平均（74．8±44．7）min。术后机械通气时间12～648h，中位数96h。全组患儿术后延期关胸13例，术后床旁开胸探查止血8例。其余主要并发症包括重症肺炎10例，肺高压危象2例，低心排综合症8例。结论早产儿或低体重儿可早期实施先心病外科手术治疗，良好的术后管理有助于降低术后病死率和并发症发生率。

英文摘要：

Objective To summarize the postoperative management of low birth weight and pre- mature infants with congenital heart disease. Methods Sixty low birth weight neonates with congenital heart disease undergoing surgical treatments from May 2003 to October 2011 were included in this study. The mean gestational age was 33.50 ± 4.07 weeks （ranged from 26 to 42 weeks）. Mean age at operation was 24. 88 ± 12. 49 days （ranged from 4to 55 d）. Mean birth weight was 1 729. 3 ± 522. 45 g （ranged from 640--2 500 g） and the weight at operation was 1 953.2 ± 463. 57 g （ranged from 650- 2 712 g）. Among these,47 were premature infants. All cases were cared in the NICU before operation. 29 cases underwent surgery without cardiopulmonary bypass （CPB）. 3 cases of the 31 cases with CPB underwent beating heart technique and 4 cases used deep hypothermia and circulatory arrest. Results 4 intra- operative deaths occurred, making the overall mortality rateof 6. 7%. 6 early deaths （72 hrs postoperatively） occurredand added 10% to the mortality rate. The total in-hospital mortality was 21.7% with 10 deaths and 3 families rejectingfurther treatments. The mean cardiopulmonary bypass time was 121. 0 -± 74. 6 min（35-326 rain）, the mean aortic clamp time was 74. 8 ± 44. 7 rain （27- 173 rain）. The mean post-operative mechanical ventilation time was 136. 9± 138. 1 hr（12-648 h）. The sternum was left open in 15 cases. 8 cases hadpost-op bleeding needingre-operation. The other main complications were pneumonia （10 cases）, pulmonary hypertension （2 cases） and low cardiac output syndrome （8 cases）. Conclusions Early surgical treatments in low birth weight neonates with congeni- tal heart diseases can bedone. More optimal postoperative managementwill contribute to lower postop- erative mortality.