婴儿左向右分流先心病伴肺动脉高压的围术期处理(附47例报告)

47-case report on perioperation management of left to right shunt congenital heart disease with pulmonary hypertension in infants

目的 探讨婴儿左向右分流先心病合并肺动脉高压的围术期处理。方法 本组 4 7例 ,年龄 (6 .1± 3.1)月 ,肺动脉收缩压 (6 4 .0± 14 .0 )mmHg ,室间隔或房间隔缺损 37例 ,动脉导管未闭 10例。围术期积极应用各项有效措施如合理运用呼吸机和扩血管药物、膜肺和超滤、动态监测肺动脉压、加强呼吸道管理等。结果 病死率 2 .1%(1/ 4 7) ,术后并发症有心功能不全、VSD残余分流等。存活 4 6例 ,呼吸机支持 (2 0 .0± 19.0 )h ,术后监护 (3.0±1.5 )d ,随访 1～ 2 4个月 ,无远期死亡 ,4 5例心功能良好。结论 只要早期进行手术治疗 ,注重围术期的综合处理和正确的防治肺动脉高压及危象 ,对伴肺动脉高压的左向右分流先心病在婴儿期可获得满意的疗效。

ObjectiveTo explore perioperation management of left to right shunt congenital heart disease with pulmonary hypertension in infants.Methods 47 patients with an age range of (6.1±3.1) months and pulmonary artery systolic pressure of (64.0±14.0)mmHg were performed cardiac surgery.37 cases demonstrated defect interventricular septum or interauricular septum and 10 cases were patent arterial duct.Comprehensive measures such as appropriate application of ventilation support,pulmonary vasodilator,membrane oxygenator and ultrafiltration,dynamic monitoring of pulmonary arterial pressure were employed in perioperation.Results one patient died after the operation with a mortality of 2.9%.Postoperative complications as low cardiac output syndrome,residual shunt occurred.Mechanical ventilation was supported with a duration of (20.0±19.0) hours followed with (3.0±1.5) days ICU stay.46 cases were conducted a follow-up of 1～24 months and 45 were in good condition.Conclusion Earlier surgical intervention,sound perioperation management and prevention of hypertensive crisis can be satisfactory for treating congenital heart disease in infants.