6 kg以下婴儿室间隔缺损外科根治术的意义及围术期处理

Repair and Treatment in perioperative period for the infants less then 6?kg of weight with ventricular septal defect

目的回顾6 kg以下室间隔缺损的手术矫治效果及围术期处理措施。方法2003年5月~2004年5月手术治疗20例6 kg以下婴儿室间隔缺损患儿,年龄47 d^11个月,平均(4.7±2.7)个月,体重2.5~6 kg,平均(4.8±0.9)kg。其中13例患儿在心内科或重症监护室(ICU)控制肺炎心衰后直接转入心外科做手术,全部患儿均在全麻低温体外循环下行I期矫治术。结果术后早期(30 d)内无死亡。术后并发症:低心排1例,心律紊乱4例,其中3例为III度房室传导阻滞,房扑1例,心包积液3例,呼吸衰竭、拔管延迟5例,胸腔积液5例,肺不张4例,经治疗均痊愈出院。结论对于反复肺炎、心衰伴肺动脉高压的室间隔缺损婴儿,应内外科医师合作,尽早行手术根治。术后注意呼吸道的管理、出入量的平衡和维护心功能。

Objective To review the efficacy of repair of ventricular septal defect and the treatment in perioperative period in the infants less than 6kg of weight. Methods From May 2003 to May 2004, 20 patients with ventrieular Septal defect less than 6 kg of weight underwent operation. The mean age was（4.7 ± 2.7） months and the mean weight was（4.8 ± 0.9）kg. In this group, 13 cases were repaired under cardiopulmonary bypass（CPB）after the controlling of pneumonia and the heart failure in the department of cardiology or ICU. Results There was no one dead in the earlier stage after the operation. The complications included low cardiac output syndrome, arrhythmia, respiratory failure, pleural effusion and atelectasis. Conclusion Infants with ventrieular septal defect which have repeated pneumonia, heart failure and pulmonary hypertension should undergo operation as earlier as possible. It is important to pay attention to the managment for disorders of respiratory system.