5kg以下婴儿室间隔缺损合并肺动脉高压的外科治疗(附72例报告)

Surgical Treatment of Ventricular Septal Defect with Pulmonary Hypertension in Infants Weighting Less Than 5 Kilograms(A Report of 72 Cases)

目的探讨5 kg以下低体重婴儿室间隔缺损（ventricular septal defect,VSD）合并肺动脉高压（pulomary hypertesion,PH）的手术治疗效果及体会。方法回顾性分析72例体重低于5kg的VSD合并PH患儿的临床资料,采用中低温体外循环下行补片修补术,11例圆锥隔型VSD采用主肺动脉切口,以Da-cron片间断褥式缝合修补;余61例采用右心房切口经三尖瓣途径修补,其中21例采用Dacron片间断褥式缝合修补,14例采用牛心包补片间断褥式缝合修补、26例采用自体心包补片5-0 Prolene线连续缝合修补。合并畸形如肌部缺损、房间隔缺损及动脉导管未闭均同期作相应处理。结果全组手术死亡5例（6.9%）,其中术后低心排综合征2例、顽固性心律失常、急性肾功能衰竭、多器官衰竭各1例,失访1例,余66例患儿随访8-41月术后复查心脏超声示肺动脉压力明显下降,生长发育良好。结论选择适当的手术时机、对心脏畸形手术矫治充分及良好的术后处理是手术治疗5 kg以下婴儿VSD合并PH成功的关键。

Objective To summarize the experiences of surgical repair of ventricular septal defect（VSD） with pulmonary hypertension（PH） in infants weighting less than 5 kilograms.Methods The clinical data of 72 infants weighting less than 5 kilograms with VSD and PH were retrospectively analyzed.All the patients underwent surgical patch repair with moderate hypothermic cardiopulmonary bypass.Through the primary pulmonary artery incision,11 cases of cone-type VSD were treated by Dacron patch with discontinuous mattress suture repair.The other 61 cases of VSD were treated through right atrium incision of which 21cases by Dacron patch and 14 cases by bovine pericardial patch with discontinuous mattress suture repair,and the other 26 cases were treated by autologous pericardial patch with 5-0 Prolene continuous suture line repair.Results Five patients died during hospitalization with a hospital mortality of 6.9%,including two cases died from low cardiac output syndrome,three other cases died from refractory arrhythmia,acute renal failure and multiple organ failure respectively.One patient lost follow-up.During 8 to 41 months follow-up,echocardiography suggested that pulmonary vascular pressure of the other 66 cases decreased obviously,and personal health assessment was comparable to that of the normal population.ConclusionThe clinical outcomes of operations on VSD with PH infants weighing less than 5 kilograms are satisfactory with appropriate surgical timing,adequate surgical correction and meticulous perioperative management.