6月内体质量<5kg小婴儿室间隔缺损的外科治疗

SURGICAL TREATMENT OF VENTRICULAR SEPTAL DEFECT IN INFANTS WEIGHING LESS THAN FIVE KILOGRAMS

①目的探讨体质量5kg以下<6个月小婴儿室间隔缺损(VSD)的外科治疗和围术期处理方法,为临床提供理论依据。②方法回顾性分析35例体质量5kg以下小婴儿(<6个月)行室间隔缺损手术治疗的临床资料,其中男15例,女20例,体质量<5.0kg,平均(4.1±0.8)kg,年龄27～182d,平均(131±17)d。所有病儿均易发生呼吸道感染,伴有肺动脉高压,其中膜周型VSD者20例,嵴内型VSD者1例,肺动脉瓣下VSD者12例,多发VSD者2例,VSD直径8～25mm,均在全麻体外循环下手术治疗。③结果术后早期死亡1例;出现并发症者13例,其中肺不张8例,低心排综合征2例,心律失常2例,胸腔积液1例,均经过治疗后痊愈出院。④结论只要把握好手术时机,掌握恰当的手术技术,完善围术期处理,体质量5kg以下小婴儿(<6个月)室间隔缺损的外科治疗可以取得满意的效果。

Objective To review the surgical outcome of ventricular septal defect （VSD） in infants weighing less than five kilograms （age〈6 months）. Methods From November 1999 to October 2004, 35 infants weighing〈5 kg （age〈6 months） received operation for their ventricular septal defects. Their body weight 〈5.0 kg （mean weight 4.1±0.8 kg） and their age from 27 days to 182 days （mean 131± 17 days）. Twenty infants had perimembranous VSD, one had infracristal VSD, 12 had suhpulmonary VSD and two had multiple VSD. The diameters of VSD were 8 to 25 ram. All cases were operated under cardiopulmonary bypass. Results There was one hospital death （1/35）. Most the complications were pulmonary atelectasis, low cardiac output syndrome and arrhythmia. Conclusion It is necessary to enhance perioperative intervention to improve the effect of surgical repair of ventricular septal defect in infants weighing〈5 kg （age〈6 months）.