外科治疗儿童室间隔缺损并重度肺动脉高压144例

Surgical treatment of 114 children with ventricular septal defect and severe pulmonary hypertension

目的 报告自1990年1月～1997年11月期间,144例室间隔缺损并重度肺动脉高压患儿的外科治疗结果。方法 全组病例术前均经心导管检查确诊,P_n/P_s(0.81±0.09),R_n(9.41±5.37)wood。在体外循环下行室缺修补术。结果 手术死亡14例,死亡率9.7％。术前P_p/Ps≥0.8和R_p≥10wood,死亡率达28.6％;存活者中超声检查估测S_pPA>50mmHg的有32例;1例术后发展成艾森曼格综合征。结论术前P_p/Ps≥0.8和/或R_p≥10wood的室缺并重度肺动脉高压者手术风险显著增大;婴幼儿室缺并重度肺动脉高压应尽早手术;术后应重视肺动脉高压危象的防治;心内测压管置入对术后并发症有重要作用。

ve To report the result of surgical treatment for 144 children with ventricular septae defect and severe pulmonary hypertension. Method The diagnosis had been confirmed by cardiac catheter before the operation, Pp/PS(0.81 ± 0.09) and RP(9.41 ± 5.37) wood. Ventricular prothesis was performed under extracorporeal circulation. Transthoracic intracardiac monitoring line inserted into pulmonary artery in 117 cases . Results Fourteen cases died of the 144 postopera-tively, with mortality of 9.72%. Preoperative PP/PS ≥ 0.8 and Rp≥ 10 wood made the mortality higher than that of others ( P < 0.05). 32 persons had post - operativeSpPA > 50 mmHg among the survivers and among the children with Preoperative Pp/Ps≥0.8 and RP≥ 10 wood the mortality was 28.6% being higher than that among those with PP/P≥0.08 and RP < 10 wood. Conclusion The higher the preoperative PP/Ps and RP are, the higher the surgical mortality is. The prevention and treatment of postoperative pulmonary hypertension crisis should be payed more attention to. The placement of transthoracic intracardiac monitoring lines plays an important role in the prevention and treatment of the complications occurred postoperationally in children with pulmonary hypertension.