Balachandran Rakhi, Nair Suresh G, Gopalraj Sunil S, Vaidyanathan Balu, Kottayil Brijesh P, Kumar Raman Krishna
Department of Anaesthesia, Division of Cardiac Anesthesia and Pediatric Cardiac Intensive Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Ann Pediatr Cardiol. 2013 Jan;6(1):6-11. doi: 10.4103/0974-2069.107225.
The evolution of surgical skills and advances in pediatric cardiac intensive care has resulted in Norwood procedure being increasingly performed in emerging economies. We reviewed the feasibility and logistics of performing stage one Norwood operation in a limited-resource environment based on a retrospective analysis of patients who underwent this procedure in our institution.
Retrospective review of medical records of seven neonates who underwent Norwood procedure at our institute from October 2010 to August 2012.
The median age at surgery was 9 days (range 5-16 days). All cases were done under deep hypothermic cardiopulmonary bypass and selective antegrade cerebral perfusion. The median cardiopulmonary bypass (CPB) time was 240 min (range 193-439 min) and aortic cross-clamp time was 130 min (range 99-159 min). A modified Blalock-Taussig (BT) shunt was used to provide pulmonary blood flow in all cases. There were two deaths, one in the early postoperative period. The median duration of mechanical ventilation was 117 h (range 71-243 h) and the median intensive care unit (ICU) stay was 12 days (range 5-16 days). Median hospital stay was 30.5 days (range 10-36 days). Blood stream sepsis was reported in four patients. Two patients had preoperative sepsis. One patient required laparotomy for intestinal obstruction.
Stage one Norwood is feasible in a limited-resource environment if supported by a dedicated postoperative intensive care and protocolized nursing management. Preoperative optimization and prevention of infections are major challenges in addition to preventing early circulatory collapse.
手术技术的发展和小儿心脏重症监护的进步使得诺伍德手术在新兴经济体中越来越多地开展。我们基于对在本院接受该手术的患者的回顾性分析，评估了在资源有限的环境下进行一期诺伍德手术的可行性和后勤保障情况。
回顾性分析2010年10月至2012年8月在本院接受诺伍德手术的7例新生儿的病历。
手术时的中位年龄为9天（范围5 - 16天）。所有病例均在深低温体外循环和选择性顺行性脑灌注下进行。中位体外循环（CPB）时间为240分钟（范围193 - 439分钟），主动脉阻断时间为130分钟（范围99 - 159分钟）。所有病例均使用改良的布莱洛克 - 陶西格（BT）分流术来提供肺血流。有2例死亡，1例发生在术后早期。机械通气的中位持续时间为117小时（范围71 - 243小时），重症监护病房（ICU）的中位住院时间为12天（范围5 - 16天）。中位住院时间为30.5天（范围10 - 36天）。4例患者报告有血流感染。2例患者术前有感染。1例患者因肠梗阻需要剖腹手术。
如果有专门的术后重症监护和规范化护理管理的支持，一期诺伍德手术在资源有限的环境中是可行的。除了预防早期循环衰竭外，术前优化和预防感染是主要挑战。
