230例婴幼儿室间隔缺损的外科治疗

Surgical treatment of ventricular septal defect in infants: report of 230 cases

目的探讨外科手术治疗婴幼儿室间隔缺损（ＶＳＤ）的结果和经验。方法对１９９０年２月至１９９７年１２月的２３０例婴幼儿ＶＳＤ修补术进行总结。年龄３～３６个月，体重３２～１５５ｋｇ。膜周部ＶＳＤ１９２例，干下型ＶＳＤ３６例，膜周部并肌部ＶＳＤ２例。术前中度以上肺动脉高压１５０例（６５２％）。结果全组手术死亡１３例，手术病死率为５６５％。手术死亡的主要原因为肺动脉高压危象和严重心律失常。术后主要并发症为肺部感染、心律失常和肺动脉高压危象。结论只要正确掌握手术时机、完善手术技术操作、采用肺动脉监测测压等监护措施、及时防治可能出现的并发症，在婴幼儿期施行ＶＳＤ修补术可以取得满意的结果。

Objective To review the experience of surgical treatment of ventricular septal defect (VSD) in infants. Methods 230 infants with VSD of less than 3 years old underwent surgical repair from Feb.1990 to Dec.1997. Their ages ranged from 3 to 36 months. Their weight was 3 2 to 15 5 kg. The number of patients with perimembranous VSD was 192, and that of subpulmonary VSD 36. Two patients had multiple VSDs. 150 patients (65 2%) had moderate or severe pulmonary hypertension before operation. Results Thirteen patients died during hospitalization period, with a hospital mortality of 5 65%. The main causes of death were pulmonary hypertensive crisis and arrhythmia. The leading complications were pulmonary infections, arrhythmia and pulmonary hypertensive crisis. Conclusions Surgical treatment of VSD in infancy may have a satisfactory outcome, it standardized surgical techniques and the improved perioperative management are used.