小儿室间隔缺损伴肺动脉高压的围手术期治疗

The perioperative treatment of children with ventricular septal defect and pulmonary hypertension

目的探讨小儿室间隔缺损(VSD)伴肺动脉高压(PH)外科治疗的围手术期治疗效果。方法回顾性分析2002年10月至2007年10月我科收治的97例小儿室间隔缺损伴肺动脉高压患儿围手术期的临床资料。结果术后死亡5例;术中并发Ⅲ度房室传导阻滞4例,再次阻断主动脉停循环后拆除隔瓣处转移针,心脏复跳后转为窦性心律;术后出现肺动脉高压危象2例,行二次气管插管呼吸机支持治疗后好转;术后肺不张9例,经纤支镜吸痰、拍背、刺激咳嗽等方法处理后肺复张;肺部感染17例,调整抗生素治疗后治愈。结论小儿室间隔缺损伴肺动脉高压的患儿围术期注重降低肺动脉压,加强围手术期综合治疗是手术治疗成功的关键。

Objective To explore the perioperative features of surgical treatment in patients of ventricular septal defect（VSD）with pulmonary hypertension（PH）.Methods From October 2002 to October 2007,clinical datas of 97 patients with VSD and PH in perioperative were retrospectively analyzed.Results Totally 5 cases died.There were 4 cases with Ⅲ A-V block after operation.And the postoperative complications included PH crisis in 2 cases,lung atelectasis in 9 cases and the 17 cases with lung infection.Follow-up was complete in all 86 survived cases for 3 to 60 months and 6 cases were missing.Conclusion Reducing the pulmonary hypertension in the perioperative and strengthen the perioperative management is the key to treat children with Ventricular Septal Defect and Pulmonary Hypertension.