39例大型房间隔缺损 室间隔缺损并发肺炎婴儿早期手术治疗的临床分析

Early surgical treatment for infants with large atrial septal defects or ventricular septal defects complicated by pneumonia:experience of 39 cases

目的婴儿大型房间隔缺损(ASD)室间、隔缺损(VSD)难以自愈,需要尽早手术纠治,以免影响发育甚至导致死亡。但是这类患儿往往并发严重的肺部感染,且反复发作,很难等到肺部感染完全治愈时进行手术纠治。同时患儿需要反复治疗肺炎,费用较高且易延误手术时机。因此,该文研究婴儿大型房间隔缺损、室间隔缺损并发肺炎的早期手术治疗的手术时机选择、治疗的可行性以及减少并发症的处理。方法2003年1月至2008年1月,收治大型ASD,VSD并发肺炎39例婴儿,36例在肺炎控制后进行早期手术治疗,3例再行儿科保守治疗。结果手术病例中,33例婴儿手术成功,2例婴儿死于气管狭窄,1例死于严重低心排,死亡率8.3%。儿科保守治疗病例中,1例在治疗中因心肺衰竭死亡;2例好转出院,择期行手术治疗成功。结论把握手术时机和适应证,做好围术期处理,在肺炎控制后对大型ASD,VSD的婴儿进行早期手术治疗是可行的,可提高和改善治疗效果并减少患者费用。

Objective This research reported the experience of early surgical treatment for infants with large atrial septal defects （ASD） or ventricular septal defects （VSD） complicated by pneumonia. Methods Between January 2003 and January 2008, 39 infants with large ASD or VSD complicated by pneumonia were admitted to the Second Xiangya Hospital. Thirty-slx patients underwent surgical repair within 7-10 days after pneumonia had been controlled. Mean age was 5.4 ± 3.4 months and mean weight was 4.7 ± 1.6 kg in the 36 patients. Three patients received conservative treatment due to uncontrolled lung infections. Results Of the 36 patients, 33 had successful surgery and 3 （ 8.3 % ） died of serious low cardiac output （ n = 1 ） or respiratory failure due to congenital tracheostenosis （ n = 2 ）. The 33 survivors showed normal growth and development in a 6 month-5 year follow-up. Of the 3 patients receiving conservative treatment, 1 died of cardiopulmonary failure and 2 were discharged after the symptoms had been improved. Conclusions With increasing medical experience and technique, early surgical operation may be performed with good outcomes in infants with large ASD or VSD complicated by pneumonia.