5kg以下婴儿室间隔缺损并肺动脉高压的外科治疗

Surgical treatment of infants below 5 kg with ventricular septal defects and pulmonary hypertension

目的总结5kg以下婴儿室间隔缺损（VSD）并肺动脉高压外科治疗的经验。方法2006年6月至2008年8月，外科治疗5奴以下婴儿VSD共34例，年龄12d至9个月，体重2．8-5．5kg。超声心动图提示VSD直径平均（9．1±3．4）mm，均有不同程度的肺动脉高压。术前予充分控制感染、改善营养状况、降低肺动脉压力以及改善心功能不全等治疗。均在浅低温体外循环心脏停跳下行VSD修补手术。术后加强处理肺动脉高压、肺部感染、心功能不全等并发症。结果全组术后无死亡。随访2-26个月，均无严重并发症发生。结论提高手术技巧和加强围术期处理是外科治疗5kg以下婴儿VSD并肺动脉高压成功的关键。

Objective To summarize the experience of surgical treatment of infants below 5 kg with ventricular septal defects （VSD） and pulmonary hypertension. Methods From June 2006 to August 2008,32 infants below 5kg with VSD, whose age ranged from 12 days to 9 months and whose weight ranged from 2.8 to 5.5 kilograms, underwent surgical correction. The diameter of VSD was 6.0 to 14 milimeters[ mean（9.1±3.4） millimeters ]. All infants had pulmonary hypertension in varying degrees by echocardiogram. All were operated under mild hypothermic cardiopulmonary bypass and arresting heart. The syndromes of infection, malnutrition, pulmonary hypertension or （and） heart failure were treated sufficiently preoperation and postoperation. Results No case died. No severe complication occurred in following up 2 to 26 months. Conclusion Improving surgical skill and strengthening perioperative care are the keys of success in surgical treatment of infants below 5 kg with ventricular septal defects and pulmonary hypertension.