婴儿室间隔缺损合并重度肺动脉高压的围术期处理

Perioperative treatment of severe ventricular septal defect with pulmonary hypertension in infants

目的:总结婴儿室间隔缺损(VSD)合并重度肺动脉高压(PH)的围术期处理经验。方法:2007年1月～10月共收治婴儿VSD伴重度PH 18例,男12例,女6例,年龄3～11月,平均(7.0±2.9)月,体重3.9～8.0 kg,平均(6.5±1.2)kg。所有患儿均在体外循环下行室间隔缺损修补术。结果:本组术后无死亡。术后并发症9例,其中低心排2例,心律失常2例,肺不张2例.肺部感染2例,二重感染1例。术后1月复查彩超,除4例有轻度PH,其余肺动脉压均恢复正常。所有患儿术后均痊愈出院。结论:精心的术前准备、术中减少体外循环损害、术后加强呼吸道管理、适宜的血流动力学支持和适当机械通气是婴儿VSD合并重度PH患儿成功治疗的重要保证。

Objective： To review the experience of treatment of perioperative period of ventricular septal defect（VSD） with severe pulmonary hypertension （PH） in younger than 1 year infants. Methods： From January to October 2007, 18 cases of VSD with severe PH at less than 1 year of age were operated. Their age ranged from 3 months to 11 months with an average of （ 7. 0 ± 2.9 ） months and weights from 3. 9 to 8 kg with an average of （6.5 ± 1.2） kg. All of the patients were repaired of their ventricular septal defect under cardiopulrnonary bypass （CPB）. Results： There was no one dead after operation. The most common postoperative complications included low cardiac output syndrome, arrhythmia, pneumonia, dual infection and atelectasis. All cases were checked by color ultrasound 1 month after operation and pulmonary hypertension in all cases was normal except for 4 cases with slight pulmonary hypertension. All patients were discharged from hospital after full rehabilitation. Conclusions： Careful preoperative preparation, reduction of the damage from extracorporeal circulation during the operation, more attention paid on the respiratory duct after operation including maintaining good hemodynamics and proper mechanical ventilation are important measures to decrease the complications and mortality.